Provider Demographics
NPI:1508982828
Name:GODLEY, JOANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:GODLEY
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 1:39 W KAMEHAMEHA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2263
Mailing Address - Country:US
Mailing Address - Phone:808-877-2424
Mailing Address - Fax:808-877-6464
Practice Address - Street 1:39 W KAMEHAMEHA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2263
Practice Address - Country:US
Practice Address - Phone:808-877-2424
Practice Address - Fax:808-877-6464
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026694-E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC29767Medicare UPIN