Provider Demographics
NPI:1558366724
Name:GODARD, JAMES L (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:GODARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1540 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4300
Mailing Address - Country:US
Mailing Address - Phone:417-823-2900
Mailing Address - Fax:417-886-2774
Practice Address - Street 1:1540 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4300
Practice Address - Country:US
Practice Address - Phone:417-823-2900
Practice Address - Fax:417-886-2774
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7G85207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1558366724Medicaid
MO242411718Medicaid
110031981OtherRR MEDICARE
D41551Medicare UPIN
015050115Medicare ID - Type Unspecified
MO1558366724Medicaid