Provider Demographics
NPI:1932941333
Name:GOODWIN, GREGORY D
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MESA CREST DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-6128
Mailing Address - Country:US
Mailing Address - Phone:812-305-3106
Mailing Address - Fax:
Practice Address - Street 1:1405 MESA CREST DR
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-6128
Practice Address - Country:US
Practice Address - Phone:812-305-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant