DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: ERIC JAMES GODDEYNE PA-C

MEDICARE: ERIC JAMES GODDEYNE PA-C
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
1363AS0400XSurgical Physician Assistant3204-23WI
2363A00000XPhysician Assistant3402-23WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386052777
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC JAMES GODDEYNE PA-C
Provider Business Mailing Address
First Line : PO BOX 19070
Second Line :
City : GREEN BAY
State : WI
Zip : 54307-9070
Country : US
Telephone Number : 920-496-4700
Fax Number :
Provider Business Practice Location Address
First Line : 1726 SHAWANO AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3216
Country : US
Telephone Number : 920-496-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2014
Last Update Date : 01/13/2026

Similar Medicare Providers

1255329983 — SARA E ADAMS PT
Practice Location Address:
1760 SHAWANO AVE
GREEN BAY, WI
54303-3216
Practice Phone: 920-499-5191
Practice Fax:
1679556526 — ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS
Practice Location Address:
1726 SHAWANO AVE
GREEN BAY, WI
54303-3216
Practice Phone: 920-433-8287
Practice Fax: 920-433-8765
1356324990 — DR. THOMAS M. FARLEY M.D.
Practice Location Address:
1726 SHAWANO AVE
GREEN BAY, WI
54303-3216
Practice Phone: 920-498-4200
Practice Fax:
1548233612 — MATTHEW L RYAN M.D.
Practice Location Address:
1726 SHAWANO AVE
GREEN BAY, WI
54303-3216
Practice Phone: 920-884-3135
Practice Fax: 920-884-3144
1851365910 — JERRY M WINKLER M.D.
Practice Location Address:
1726 SHAWANO AVE
GREEN BAY, WI
54303-3216
Practice Phone: 920-884-3135
Practice Fax: 920-884-3144
1649246877 — ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC.-HOSPITAL SISTERS
Practice Location Address:
1726 SHAWANO AVE
GREEN BAY, WI
54303-3216
Practice Phone: 920-498-4200
Practice Fax:

Directions to “ ERIC JAMES GODDEYNE PA-C” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.