Provider Demographics
NPI:1881747632
Name:MACIAS, ENRIQUE GODINEZ (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:GODINEZ
Last Name:MACIAS
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 1:66530 AULT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8154
Mailing Address - Country:US
Mailing Address - Phone:740-632-0689
Mailing Address - Fax:
Practice Address - Street 1:66530 AULT DRIVE
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8154
Practice Address - Country:US
Practice Address - Phone:740-632-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics