Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 00377 | WV |
Y | 222Z00000X | Podiatrist | 00377 | WV |
NPI | 1043216260 |
---|---|
Provider Name | Joseph H Goodwin |
First Address | Wheeling, WV 26003-0711 |
Second Address | Wheeling, WV 26003-3859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2102048000 | (05) | WV |
2375031 | (05) | OH |
U70737 | (02) |