Provider Demographics
NPI:1518248855
Name:PAUL J GODIN MD INC A CALIFORNIA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PAUL J GODIN MD INC A CALIFORNIA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GODIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-576-9617
Mailing Address - Street 1:413 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-2059
Mailing Address - Country:US
Mailing Address - Phone:650-576-9617
Mailing Address - Fax:650-230-1225
Practice Address - Street 1:143 BIRCH ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1306
Practice Address - Country:US
Practice Address - Phone:650-576-9617
Practice Address - Fax:650-230-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty