Provider Demographics
NPI:1659478196
Name:DAVID M GODAT MD PA
Entity Type:Organization
Organization Name:DAVID M GODAT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GODAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-248-0899
Mailing Address - Street 1:PO BOX 195249
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-8604
Mailing Address - Country:US
Mailing Address - Phone:469-248-0899
Mailing Address - Fax:469-206-7552
Practice Address - Street 1:11970 N. CENTRAL EXPRESSWAY
Practice Address - Street 2:SUITE: 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:469-248-0899
Practice Address - Fax:214-481-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM07332082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY44698Medicare UPIN
TX8F1662Medicare PIN