Healthcare Provider Details

I. General information

NPI: 1316214588
Provider Name (Legal Business Name): JOSHUA SEAN GODSEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S PATTERSON BLVD STE 400
DAYTON OH
45402-2642
US

IV. Provider business mailing address

1318 MEADOWVIEW DR
MIAMISBURG OH
45342-3210
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-2620
  • Fax:
Mailing address:
  • Phone: 937-247-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number58-004195
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: