Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | F6674 | TX |
NPI | 1306824578 |
---|---|
Provider Name | Cameron Godfrey |
First Address | Wichita Falls, TX 76310-1123 |
Second Address | Wichita Falls, TX 76310-1123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 06/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1171811-01 | (05) | TX |
B23025 | UPIN (01) | TX |