MEDICARE: DR. JOSEPH HOLLIS GODWIN 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
1	207Q00000X	Family Medicine Physician	R9067	TX

General Provider Information

NPI Number	:	1477902518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH HOLLIS GODWIN D.O.

Provider Business Mailing Address
First Line	:	122 W JOHN CARPENTER FWY STE 420
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2014
Country	:	US
Telephone Number	:	214-330-0137
Fax Number	:	214-333-7343

Provider Business Practice Location Address
First Line	:	2815 S HAMPTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-2329
Country	:	US
Telephone Number	:	214-330-0137
Fax Number	:	214-333-7343

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

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	09/21/2020

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