MEDICARE: MARK J GODAT MD PA

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1134281405	OTHER	TX	OBSTETRICS AND GYNECOLOBY
2	1275198988	OTHER	TX	OBSTETRICS AND GYNECOLOGY

General Provider Information

NPI Number	:	1316758998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK J GODAT MD PA

Provider Business Mailing Address
First Line	:	7009 LAKE EDGE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2368
Country	:	US
Telephone Number	:	214-893-8065
Fax Number	:	214-696-9483

Provider Business Practice Location Address
First Line	:	12201 MERIT DR STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3117
Country	:	US
Telephone Number	:	469-840-4888
Fax Number	:	469-840-4886

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	JAN SMITH GODAT
Credential	:
Telephone Number	:	214-893-8065

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/16/2025

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