Individual
STEPHEN E GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10010 KENNERLY ROAD, ST LOUIS, MO 63128
(314) 525-4345
(314) 525-4354
Mailing address
5675-D GOLF RIDGE DRIVE, ST LOUIS, MO 63128
(314) 401-5161
(314) 525-4354
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
R2C59
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201838810
—
MO
01
—
220027908
RAILROAD MEDICARE
—
Enumeration date
10/20/2005
Last updated
07/23/2008
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