Individual
MARK KIMBALL GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5121 S. COTTONWOOD STREET, IMC, DIVISION OF PULMONARY/CCM, MURRAY, UT 84107
(801) 507-4000
Mailing address
5121 S. COTTONWOOD STREET, IMC, DIVISION OF PULMONARY/CCM, MURRAY, UT 84123
(801) 507-4000
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
293990-1205
UT
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD00046412
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD26606
OR
207RP1001X
Pulmonary Disease Physician
293990-1205
UT
207RP1001X
Pulmonary Disease Physician
MD00046412
WA
207RP1001X
Pulmonary Disease Physician
MD26606
OR
Other
Enumeration date
10/20/2006
Last updated
01/21/2009
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