MEDICARE: TERESA ELAINE GODBEY M.D.

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	G9330	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437192853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ELAINE GODBEY M.D.

Provider Business Mailing Address
First Line	:	5450 CLEARFORK MAIN ST STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3559
Country	:	US
Telephone Number	:	817-334-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 CLEARFORK MAIN ST STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3559
Country	:	US
Telephone Number	:	817-334-1400
Fax Number	:	817-334-1410

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	10/24/2019

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