Individual
JENNIFER GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1050 GAIL GARDNER WAY STE 100, PRESCOTT, AZ 86305-1631
(928) 777-0700
(928) 445-4464
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
32040
SC
207Q00000X
Family Medicine Physician
Primary
63630
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
094505
—
AZ
05
—
320405
—
SC
Enumeration date
07/10/2009
Last updated
02/17/2025
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