Provider Demographics
NPI:1639565872
Name:GODDARD, LINDSEY (MD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:GODDARD
Suffix:
Gender:F
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:PO BOX 141391
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99214-1391
Mailing Address - Country:US
Mailing Address - Phone:918-346-4623
Mailing Address - Fax:
Practice Address - Street 1:510 N 17TH AVE STE C
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4281
Practice Address - Country:US
Practice Address - Phone:715-849-5333
Practice Address - Fax:715-849-4083
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1893-320207NS0135X, 207ND0101X
WAMD61065973207N00000X
AZ65556207N00000X
IDMC-1248207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery