MEDICARE: DR. ELIOT W. GODOFSKY 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	207RI0200X	Infectious Disease Physician	ME65833	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25086	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134120942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIOT W. GODOFSKY M.D.

Provider Business Mailing Address
First Line	:	6010 POINTE WEST BLVD
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5531
Country	:	US
Telephone Number	:	941-746-2711
Fax Number	:	941-746-3433

Provider Business Practice Location Address
First Line	:	6010 POINTE WEST BLVD
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5531
Country	:	US
Telephone Number	:	941-746-2711
Fax Number	:	941-746-3433

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/08/2007

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