Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2008-01084 | NC |
N | 208600000X | Surgeon | 2008-01084 | NC |
Y | 2086S0129X | Vascular Surgeon | 2008-01084 | NC |
NPI | 1134199128 |
---|---|
Provider Name | Christopher J Godshall |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 12/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200478930 | (05) | IN |
50004546 | PASSPORT (01) | KY |
5910310 | (05) | NC |
64084239 | (05) | KY |
I04497 | (02) |