Provider Demographics
NPI:1629082086
Name:CODDINGTON, JOHN WILBUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILBUR
Last Name:CODDINGTON
Suffix:
Gender:M
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:HOVEN
Mailing Address - State:SD
Mailing Address - Zip Code:57450-0158
Mailing Address - Country:US
Mailing Address - Phone:605-948-2262
Mailing Address - Fax:
Practice Address - Street 1:512 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOVEN
Practice Address - State:SD
Practice Address - Zip Code:57450-0158
Practice Address - Country:US
Practice Address - Phone:605-948-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7662208D00000X
MO27860208D00000X
ND7256208D00000X
CAA28968208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice