Provider Demographics
NPI:1942391289
Name:GODDARD, DANIEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:GODDARD
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 1:9679 LAKE NONA VILLAGE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7310
Mailing Address - Country:US
Mailing Address - Phone:407-826-1895
Mailing Address - Fax:321-203-4601
Practice Address - Street 1:9679 LAKE NONA VILLAGE PL STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7310
Practice Address - Country:US
Practice Address - Phone:407-826-1895
Practice Address - Fax:321-203-4601
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593582765OtherGOLDEN RULE PROVIDER #
FL10D1007057OtherC.L.I.A. #
FL593582765OtherCHAMPUS/TRICARE #
FL51801387OtherAETNA PROVIDER #
FL593582765OtherBEECH STREET INSURANCE
FLBD4403161OtherD.E.A. #
FL28143OtherBLUE CROSS BLUE SHIELD
FL593582765OtherCIGNA
FL593582765OtherUNITED HEALTH CARE
FL593582765OtherSRC-AETNA
FL593582765OtherP.H.C.S. INSURANCE
FL593582765OtherF.H.H.S. INSURANCE
FL593582765OtherAV-MED
FL378940300Medicaid
FL593582765OtherGREAT WEST PROVIDER #
FL593582765OtherHUMANA GOLD PLUS
FL593582765OtherWELLCARE
FLME61279OtherFLORIDA STATE LICENSE #
FL593582765OtherUNITED HEALTH CARE
FL593582765OtherHUMANA GOLD PLUS