Provider Demographics
NPI:1700909645
Name:GOODWIN, JEAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4925 FORT CROCKETT BLVD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-6003
Mailing Address - Country:US
Mailing Address - Phone:409-762-1101
Mailing Address - Fax:409-762-1163
Practice Address - Street 1:4925 FORT CROCKETT BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-6003
Practice Address - Country:US
Practice Address - Phone:409-762-1101
Practice Address - Fax:409-762-1163
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3945102L00000X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine