Provider Demographics
NPI:1649211194
Name:GODET, ANDRE' S (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE'
Middle Name:S
Last Name:GODET
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 1:3841 PIPER ST STE T300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4624
Mailing Address - Country:US
Mailing Address - Phone:907-563-3103
Mailing Address - Fax:907-561-1862
Practice Address - Street 1:3841 PIPER ST STE T300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4624
Practice Address - Country:US
Practice Address - Phone:907-563-3103
Practice Address - Fax:907-561-1862
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3997208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD07491Medicaid
AKF90978Medicare UPIN
AKMD07491Medicaid