MEDICARE: ASA LAWRENCE GODBEY JR. MD

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	2084P0800X	Psychiatry Physician	ME0011152	FL

General Provider Information

NPI Number	:	1316907850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASA LAWRENCE GODBEY JR. MD

Provider Business Mailing Address
First Line	:	2830 NW 41ST ST
Second Line	:	STE B
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6667
Country	:	US
Telephone Number	:	352-372-0387
Fax Number	:	352-372-0387

Provider Business Practice Location Address
First Line	:	2830 NW 41ST ST
Second Line	:	STE B
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6667
Country	:	US
Telephone Number	:	352-372-0387
Fax Number	:	352-372-0387

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	05/05/2009

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