Provider Demographics
NPI:1336248830
Name:DYNE, GODFREY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:GODFREY
Middle Name:DAVID
Last Name:DYNE
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 1:816 N MILPAS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-3031
Mailing Address - Country:US
Mailing Address - Phone:805-965-8284
Mailing Address - Fax:805-962-0429
Practice Address - Street 1:816 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3031
Practice Address - Country:US
Practice Address - Phone:805-965-8284
Practice Address - Fax:805-962-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14270AMedicare PIN
CAF26703Medicare UPIN
CAW14270Medicare PIN