Provider Demographics
NPI:1437192853
Name:GODBEY, TERESA ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ELAINE
Last Name:GODBEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3559
Mailing Address - Country:US
Mailing Address - Phone:817-334-1400
Mailing Address - Fax:
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3559
Practice Address - Country:US
Practice Address - Phone:817-334-1400
Practice Address - Fax:817-334-1410
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098046801Medicaid
TX098046803Medicaid
TX098046803Medicaid
TX80X103Medicare PIN
TX11094168OtherRAILROAD MEDICARE