Provider Demographics
NPI:1124179429
Name:GODFREY, STEPHANY TRUEX (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANY
Middle Name:TRUEX
Last Name:GODFREY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:STEPHANY
Other - Middle Name:LINN
Other - Last Name:TRUEX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 FORGE VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-2047
Mailing Address - Country:US
Mailing Address - Phone:978-449-0282
Mailing Address - Fax:978-449-0289
Practice Address - Street 1:1 FORGE VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-2047
Practice Address - Country:US
Practice Address - Phone:978-449-0282
Practice Address - Fax:978-449-0289
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1971207Q00000X
MA250071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine