Healthcare Provider Details

I. General information

NPI: 1477902518
Provider Name (Legal Business Name): JOSEPH HOLLIS GODWIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S HAMPTON RD
DALLAS TX
75224-2329
US

IV. Provider business mailing address

122 W JOHN CARPENTER FWY STE 420
IRVING TX
75039-2014
US

V. Phone/Fax

Practice location:
  • Phone: 214-330-0137
  • Fax: 214-333-7343
Mailing address:
  • Phone: 214-330-0137
  • Fax: 214-333-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: