MEDICARE: WILLIAM J GODFREY MD

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	207R00000X	Internal Medicine Physician	14455	KY

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	:	1316938566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J GODFREY MD

Provider Business Mailing Address
First Line	:	914 N DIXIE AVE
Second Line	:	STE 304
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2520
Country	:	US
Telephone Number	:	270-769-1049
Fax Number	:	270-735-1978

Provider Business Practice Location Address
First Line	:	914 N DIXIE AVE
Second Line	:	STE 304
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2520
Country	:	US
Telephone Number	:	270-769-1049
Fax Number	:	270-735-1978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	11/16/2009

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Directions to “ WILLIAM J GODFREY MD” Practice Location

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