Provider Demographics
NPI:1043216260
Name:GOODWIN, JOSEPH H (DPM)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 JACOB ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-1934
Mailing Address - Country:US
Mailing Address - Phone:304-905-0590
Mailing Address - Fax:304-905-9458
Practice Address - Street 1:3500 JACOB ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-1934
Practice Address - Country:US
Practice Address - Phone:304-905-0590
Practice Address - Fax:304-905-9458
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00377213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2102048000Medicaid
OH2375031Medicaid
OH2375031Medicaid
U70737Medicare UPIN