MEDICARE: STEPHEN E GODAR MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	34790	CO
2	207R00000X	Internal Medicine Physician	34790	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043356892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN E GODAR MD PC

Provider Business Mailing Address
First Line	:	PO BOX 905
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-0905
Country	:	US
Telephone Number	:	970-867-4911
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 PROSPECT ST
Second Line	:	SUITE A
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-3161
Country	:	US
Telephone Number	:	970-867-4911
Fax Number	:

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MRS. SHELLEY HARPER
Credential	:
Telephone Number	:	970-867-4911

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	04/02/2008

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