Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MB07600800 | NJ |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | OS012799 | PA |
NPI | 1043239973 |
---|---|
Provider Name | Dean M Godfrey |
First Address | Fairmont, WV 26554-9375 |
Second Address | Lancaster, PA 17601-2426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 22/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I25884 | (02) | NJ |