Individual
MICHAEL WILLIAM GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 N BROADWAY AVE STE 300, SHAWNEE, OK 74801-6939
(405) 395-0399
(405) 395-0330
Mailing address
130 N BROADWAY AVE STE 300, SHAWNEE, OK 74801-6939
(405) 395-0399
(405) 395-0330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10925
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100094730D
—
OK
Enumeration date
07/06/2006
Last updated
01/11/2023
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