Provider Demographics
NPI:1780910364
Name:GODDARD, KRISTOPHER JOSEPH SEAN (DO)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:JOSEPH SEAN
Last Name:GODDARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3915 BISCAYNE BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3737
Mailing Address - Country:US
Mailing Address - Phone:305-367-1176
Mailing Address - Fax:877-391-0039
Practice Address - Street 1:3915 BISCAYNE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3737
Practice Address - Country:US
Practice Address - Phone:305-367-1176
Practice Address - Fax:877-391-0039
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10979207QS0010X, 207QS0010X
TN2081207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0045LOtherBCBS