Provider Demographics
NPI:1346425329
Name:GODFREY F. MIX, D.P.M., INC.
Entity Type:Organization
Organization Name:GODFREY F. MIX, D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MIX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:916-732-2277
Mailing Address - Street 1:5025 J ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3839
Mailing Address - Country:US
Mailing Address - Phone:916-732-2277
Mailing Address - Fax:916-732-2280
Practice Address - Street 1:5025 J ST
Practice Address - Street 2:SUITE 316
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3839
Practice Address - Country:US
Practice Address - Phone:916-732-2277
Practice Address - Fax:916-732-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1227213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10840Medicare UPIN
CA000E12270Medicare PIN