Individual
CHARLES GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
30 N 1900 E, ROOM 4C104, SALT LAKE CITY, UT 84132-0002
(801) 581-7606
Mailing address
310 E 500 S APT 408, SALT LAKE CITY, UT 84111-3360
(312) 933-2417
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10093959-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/01/2015
Last updated
10/13/2016
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