Provider Demographics
NPI:1578637229
Name:GODDARD AND ASSOCIATES MD PA
Entity Type:Organization
Organization Name:GODDARD AND ASSOCIATES MD PA
Other - Org Name:A. ROBERT GODDARD, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-667-2597
Mailing Address - Street 1:7211 SW 62ND AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4826
Mailing Address - Country:US
Mailing Address - Phone:305-667-2597
Mailing Address - Fax:305-669-9907
Practice Address - Street 1:7211 SW 62ND AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4826
Practice Address - Country:US
Practice Address - Phone:305-667-2597
Practice Address - Fax:305-669-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0008130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD59227Medicare UPIN