Provider Demographics
NPI:1083009823
Name:GODFREY, MARTHA (MD, MS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ANNE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 UNIVERSITY OF NEW MEXICO # 105530
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-4161
Mailing Address - Fax:505-272-2776
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO # 105610
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-6511
Practice Address - Country:US
Practice Address - Phone:505-272-4161
Practice Address - Fax:505-272-2776
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD-2022-1504208600000X
NM390200000X
FLTRN29524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program