Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | ME21281 | FL |
NPI | 1902830375 |
---|---|
Provider Name | W Jarrard Goodwin |
First Address | Miami, FL 33101-6960 |
Second Address | Miami, FL 33101-6960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 10/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0395587-00 | (05) | FL |
95496 | (02) | FL |
D78920 | (02) | FL |