Provider Demographics
NPI:1366744260
Name:GEORGE GOODKIN DPM DOM
Entity type:Organization
Organization Name:GEORGE GOODKIN DPM DOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM DOM
Authorized Official - Phone:505-353-1722
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE BLDG D12
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1534
Mailing Address - Country:US
Mailing Address - Phone:505-353-1722
Mailing Address - Fax:505-797-3566
Practice Address - Street 1:7520 MONTGOMERY BLVD NE BLDG D12
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1534
Practice Address - Country:US
Practice Address - Phone:505-353-1722
Practice Address - Fax:505-797-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-28
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM532171100000X
NM254213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty