Provider Demographics
NPI:1710001565
Name:GODOY, GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:GODOY
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 1:790 IVES DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2425
Mailing Address - Country:US
Mailing Address - Phone:305-405-0365
Mailing Address - Fax:305-405-0370
Practice Address - Street 1:790 IVES DAIRY RD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-2425
Practice Address - Country:US
Practice Address - Phone:305-405-0365
Practice Address - Fax:305-405-0370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376822800Medicaid
FLME0065758OtherLICENSE NUMBER
26390XOtherMEDICARE ID
FLME0065758OtherLICENSE NUMBER