Provider Demographics
NPI:1497714737
Name:CISCO-GOFF, JODI M (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:CISCO-GOFF
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1200
Mailing Address - Fax:304-691-1287
Practice Address - Street 1:77 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3451
Practice Address - Country:US
Practice Address - Phone:304-792-1847
Practice Address - Fax:304-792-1849
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-12-03
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Provider Licenses
StateLicense IDTaxonomies
WV20768208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64050750Medicaid
WV1812173000Medicaid
OH2327762Medicaid
WV1812173000Medicaid
KY64050750Medicaid