Provider Demographics
NPI:1942710348
Name:GODSEY, JOSHUA MATTHEW (IDC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MATTHEW
Last Name:GODSEY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VICTOR WHARF ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3400
Mailing Address - Country:US
Mailing Address - Phone:808-474-2532
Mailing Address - Fax:
Practice Address - Street 1:2001 VICTOR WHARF ACCESS RD
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3400
Practice Address - Country:US
Practice Address - Phone:808-474-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty