Provider Demographics
NPI:1790872661
Name:GODEHN, DONALD JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOHN
Last Name:GODEHN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:D.
Other - Middle Name:JOHN
Other - Last Name:GODEHN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:506 PARK HILL CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4265
Mailing Address - Country:US
Mailing Address - Phone:828-693-0275
Mailing Address - Fax:
Practice Address - Street 1:506 PARK HILL CT
Practice Address - Street 2:SUITE 1
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4265
Practice Address - Country:US
Practice Address - Phone:828-693-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21561207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936058Medicaid
NC201830Medicare ID - Type Unspecified
NC8936058Medicaid