Provider Demographics
NPI:1982610044
Name:GOODWIN, REGINALD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:JOSEPH
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 MCCLELLAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9658
Mailing Address - Country:US
Mailing Address - Phone:406-443-5455
Mailing Address - Fax:
Practice Address - Street 1:191 MCCLELLAN CREEK RD
Practice Address - Street 2:
Practice Address - City:CLANCY
Practice Address - State:MT
Practice Address - Zip Code:59634-9658
Practice Address - Country:US
Practice Address - Phone:406-443-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine