Provider Demographics
NPI:1477902518
Name:GODWIN, JOSEPH HOLLIS (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HOLLIS
Last Name:GODWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:122 W JOHN CARPENTER FWY STE 420
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2014
Mailing Address - Country:US
Mailing Address - Phone:214-330-0137
Mailing Address - Fax:214-333-7343
Practice Address - Street 1:2815 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-2329
Practice Address - Country:US
Practice Address - Phone:214-330-0137
Practice Address - Fax:214-333-7343
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty