Provider Demographics
NPI:1588907166
Name:GOODWIN, ANNIE GAO (MD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:GAO
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12901 BRUCE B DOWNS BLVD
Mailing Address - Street 2:MDC 41
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:FL 4
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:409-772-3695
Practice Address - Fax:832-632-7866
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ8480208000000X, 2080P0206X
NH256802080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics