Provider Demographics
NPI:1184621948
Name:GODBOUT, BRETT PATRICK (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:PATRICK
Last Name:GODBOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2323
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041621L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0427799000OtherAMERIHEALTH
1353362OtherCIGNA HEALTHCARE
328815OtherHEALTH AMERICA/HEALTH ASS
0427799000OtherKEYSTONE HEALTH EAST
1459385OtherPRIVATE HEALTHCARE SYSTEM
605276OtherFIRST PRIORITY LIFE INS.
819550OtherFIRST PRIORITY HEALTH
PA0012062330001Medicaid
200007508OtherRAILROAD MEDICARE
328815OtherHIGHMARK BLUE SHIELD
01195901OtherKEYSTONE HEALTH CENTRAL
088884OtherAETNA
2170505OtherMAMSI
0427799000OtherINDEPENDENCE BLUE CROSS
50044348OtherCAPITAL BLUE CROSS
13294OtherGEISINGER HEALTH PLAN
1553795OtherUNITED HEALTHCARE
P379431OtherOXFORD HEALTH PLANS
P379431OtherOXFORD HEALTH PLANS
1353362OtherCIGNA HEALTHCARE