Individual
MARVIN JORDAN GODNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 PUEBLO MAIN STREET, SAN FELIPE PUEBLO, NM 87001
(505) 867-3365
Mailing address
2313 CALLE COLIBRI, SANTA FE, NM 87505-6301
(505) 983-0507
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
75-38
NM
Other
Enumeration date
08/02/2006
Last updated
07/08/2007
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