Individual
DR. GREGORY R GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
100 HOSPITAL DR, LEBANON, MO 65536-9210
(417) 533-6100
(417) 533-6173
Mailing address
100 HOSPITAL DR, LEBANON, MO 65536-9210
(417) 533-6100
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
102077
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689780744
—
MO
01
—
431767432
TRICARE
MO
Enumeration date
08/22/2006
Last updated
08/05/2015
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