Jerry L Goddard
Family Doctor Family Doctor - Sports Medicine
305 W Jackson St Ste 200
Carbondale
, Illinois 62901-1474
Jerry L Goddard
Family Doctor Family Doctor - Sports Medicine
305 W Jackson St Ste 200
Carbondale
, Illinois 62901-1474
(618) 453-1102
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About
Features
Specialties
- Family Doctor
- Family Doctor - Sports Medicine
Languages spoken
- English
Location
First Address
- Jerry L Goddard
- 305 W Jackson St Ste 200
- Carbondale, IL
- Zip : 62901-1474
- Fax : (618) 453-1102
- Phone : (618) 536-6621
Second Address
- Jerry L Goddard
- 305 W Jackson St Ste 200
- Carbondale, IL
- Zip : 62901-1474
- Fax : (618) 453-1102
- Phone : (618) 536-6621
Reviews
FAQs
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What type of doctor is Jerry L Goddard
In what state does Jerry L Goddard practice in?
Where is Jerry L Goddard ’s practice located?
What is Jerry L Goddard ’s gender?
Is Jerry L Goddard a sole practitioner?
Is Jerry L Goddard accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Q00000X | Family Doctor | 036-054846 | IL |
| N | 207QS0010X | Family Doctor - Sports Medicine | 036-054846 | IL |
National Provider Identifier
| NPI | 1295711240 |
|---|---|
| Provider Name | Jerry L Goddard |
| First Address | Carbondale, IL 62901-1474 |
| Second Address | Carbondale, IL 62901-1474 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/12/2005 |
| Last Update Date | 28/12/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036054846 | (05) | IL |
| C39898 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.