Provider Demographics
NPI:1548486251
Name:GOODWIN, CRISTINE LORRAINE (MD)
Entity type:Individual
Prefix:
First Name:CRISTINE
Middle Name:LORRAINE
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 1:1301 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3598
Mailing Address - Country:US
Mailing Address - Phone:785-229-3367
Mailing Address - Fax:785-229-8416
Practice Address - Street 1:1428 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3547
Practice Address - Country:US
Practice Address - Phone:785-229-8882
Practice Address - Fax:785-229-8883
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine