Provider Demographics
NPI:1225237506
Name:GODOY, EUGENE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:GODOY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W THOMAS RD FL 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4226
Mailing Address - Country:US
Mailing Address - Phone:602-631-9873
Mailing Address - Fax:602-631-4093
Practice Address - Street 1:521 W THOMAS RD FL 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4226
Practice Address - Country:US
Practice Address - Phone:602-631-9873
Practice Address - Fax:602-631-4093
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1429363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical