Individual
DR. GRADY G. GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3500 GASTON AVE, 4 ROBERTS, DALLAS, TX 75246-2017
(214) 820-3000
(214) 820-3022
Mailing address
3500 GASTON AVE, 4 ROBERTS, DALLAS, TX 75246-2017
(214) 820-3000
(214) 820-3022
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M4160
TX
208M00000X
Hospitalist Physician
M4106
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184835001
—
TX
05
—
184835002
—
TX
01
—
8CZ855
BCBSTX
TX
01
—
8G0895
BCBS
TX
Enumeration date
08/25/2006
Last updated
07/26/2012
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