Provider Demographics
NPI:1437458601
Name:GOODWIN, SALLY A (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 WOODLAND HALL LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-8628
Mailing Address - Country:US
Mailing Address - Phone:360-579-1586
Mailing Address - Fax:
Practice Address - Street 1:3677 WOODLAND HALL LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8628
Practice Address - Country:US
Practice Address - Phone:360-579-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00023404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine