Provider Demographics
NPI:1538176466
Name:GOODKIN, KARL (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:
Last Name:GOODKIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-439-8000
Mailing Address - Fax:423-439-2200
Practice Address - Street 1:512 VICTORIA LN STE 13
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3228
Practice Address - Country:US
Practice Address - Phone:956-296-3821
Practice Address - Fax:956-296-3820
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG505382084P0800X
TNMD521382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0613380-00Medicaid
FL0613380-00Medicaid
FLB23070Medicare UPIN