Provider Demographics
NPI:1457385924
Name:GOODWIN, MEREDITH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:ANN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 W CALL ST
Mailing Address - Street 2:DEPT. FAMILY MEDICINE/RURAL HEALTH, FSU COLL OF MEDICIN
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-3556
Mailing Address - Country:US
Mailing Address - Phone:850-644-9454
Mailing Address - Fax:850-645-2859
Practice Address - Street 1:10535 HOSPITAL WAY BLDG 650
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4200
Practice Address - Country:US
Practice Address - Phone:916-843-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG064592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG064592OtherSTATE MEDICAL LICENSE