Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC005771 | PA |
Y | 222Z00000X | Podiatrist | SC005771 | PA |
N | 213ES0131X | Foot Surgery | N006304-1 | NY |
N | 213ES0131X | Foot Surgery | N006304-2 | NY |
NPI | 1285839134 |
---|---|
Provider Name | Dr. Daniel Eugene Godfrey |
First Address | Erie, PA 16502-2858 |
Second Address | Erie, PA 16502-2858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 09/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P020106304 | EXCELLUS BLUE CROSS BLUE SHIELD (01) | NY |