Provider Demographics
NPI:1801831136
Name:GODFREY, PAULA J (DO)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:GODFREY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 CURTIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-9144
Mailing Address - Country:US
Mailing Address - Phone:360-262-9118
Mailing Address - Fax:
Practice Address - Street 1:341 CURTIS HILL RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-9144
Practice Address - Country:US
Practice Address - Phone:360-262-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002213207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8903687Medicare PIN