Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 38684 | CA |
Y | 213EG0000X | General Practice | 38684 | CA |
NPI | 1003004698 |
---|---|
Provider Name | Dr. Merle Franklin Godfrey III |
First Address | Loomis, CA 95650-2178 |
Second Address | Loomis, CA 95650-7400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 18/04/2014 |