Provider Demographics
NPI:1699765099
Name:GOODWIN, JAMES E (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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:PO BOX 27957
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0957
Mailing Address - Country:US
Mailing Address - Phone:908-835-1910
Mailing Address - Fax:908-835-1886
Practice Address - Street 1:315 STATE ROUTE 31 S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4069
Practice Address - Country:US
Practice Address - Phone:908-689-0777
Practice Address - Fax:908-835-3037
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1129104Medicaid
NJP00120593OtherRAILROAD MEDICARE
C34980Medicare UPIN
NJ1129104Medicaid