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NPI Code Detail

MEDICARE: KRISTOPHER JOSEPH SEAN GODDARD D.O.

MEDICARE: KRISTOPHER JOSEPH SEAN GODDARD D.O.
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
1207QS0010XSports Medicine (Family Medicine) PhysicianOS10979FL
2207QS0010XSports Medicine (Family Medicine) Physician2081TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10045LOTHERFLBCBS

General Provider Information

NPI Number : 1780910364
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTOPHER JOSEPH SEAN GODDARD D.O.
Provider Business Mailing Address
First Line : 3915 BISCAYNE BLVD STE 406
Second Line :
City : MIAMI
State : FL
Zip : 33137-3737
Country : US
Telephone Number : 305-367-1176
Fax Number : 877-391-0039
Provider Business Practice Location Address
First Line : 3915 BISCAYNE BLVD STE 406
Second Line :
City : MIAMI
State : FL
Zip : 33137-3737
Country : US
Telephone Number : 305-367-1176
Fax Number : 877-391-0039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2009
Last Update Date : 02/16/2022

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