Basic Information
| Provider Information | |||||||||
| NPI: | 1457385924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODWIN | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 W CALL ST | ||||||||
| Address2: | DEPT. FAMILY MEDICINE/RURAL HEALTH, FSU COLL OF MEDICIN | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323043556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506449454 | ||||||||
| FaxNumber: | 8506452859 | ||||||||
| Practice Location | |||||||||
| Address1: | 10535 HOSPITAL WAY BLDG 650 | ||||||||
| Address2: | |||||||||
| City: | MATHER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956554200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168437000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G064592 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | G064592 | 01 | CA | STATE MEDICAL LICENSE | OTHER |