Individual
DR. JEREMY LR GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, MD
Contact information
Practice address
1456 PROFESSIONAL DR STE 402, PETALUMA, CA 94954-6639
(707) 938-7951
(707) 938-7260
Mailing address
1456 PROFESSIONAL DR STE 402, PETALUMA, CA 94954-6639
(707) 938-7951
(707) 938-7260
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G76323
CA
208VP0000X
Pain Medicine Physician
G76323
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138326
OMAP
OR
01
—
R113031
NORIDAN
OR
Enumeration date
09/13/2006
Last updated
06/06/2023
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