Individual
RICHARD LEWIS GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1710 S 74TH ST, MESA, AZ 85209-4136
(602) 332-6267
Mailing address
1710 S 74TH ST, MESA, AZ 85209-4136
(602) 332-6267
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5102
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5102
PROFESSIONA FOSTER HOME
AZ
Enumeration date
04/11/2008
Last updated
04/11/2008
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