Provider Demographics
NPI:1386948842
Name:GEORGE GOODKIN DPM DOM PC
Entity type:Organization
Organization Name:GEORGE GOODKIN DPM DOM PC
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:DFPM
Authorized Official - Phone:505-353-1722
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:BLDG D-12
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1521
Mailing Address - Country:US
Mailing Address - Phone:505-881-9764
Mailing Address - Fax:505-881-9774
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:BLDG D-12
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1521
Practice Address - Country:US
Practice Address - Phone:505-881-9764
Practice Address - Fax:505-881-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM532332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies