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NPI Code Detail

MEDICARE: ROY GODDARD JR. D.O.

MEDICARE: ROY GODDARD JR. D.O.
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
1207P00000XEmergency Medicine Physician2523OK

General Provider Information

NPI Number : 1437155710
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY GODDARD JR. D.O.
Provider Business Mailing Address
First Line : PO BOX 8190
Second Line :
City : ALTUS
State : OK
Zip : 73522-8190
Country : US
Telephone Number : 580-482-4781
Fax Number : 580-481-2345
Provider Business Practice Location Address
First Line : 1200 E PECAN ST
Second Line :
City : ALTUS
State : OK
Zip : 73521-6141
Country : US
Telephone Number : 580-482-4781
Fax Number : 580-481-2345
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 07/08/2007

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Directions to “ ROY GODDARD JR. D.O.” Practice Location

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