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Individual
DR. CHARLES JEFFERY GOODWIN
Active
Individual
DR. CHARLES JEFFERY GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01061089A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000565585
ANTHEM FACET
—
01
—
01061089A
MEDICAL LICENSE
IN
05
—
200913700
—
IN
01
—
41679
MEDICAL LICENSE
KY
05
—
7100059660
—
KY
Enumeration date
03/18/2007
Last updated
02/18/2014
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