Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | H5772 | TX |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | H5772 | TX |
NPI | 1568522019 |
---|---|
Provider Name | Dr. Karen Godfrey |
First Address | Bedford, TX 76021-2526 |
Second Address | Fort Worth, TX 76107-4600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 02/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E43910 | (02) | TX |