Individual
ERIC JAMES GODDEYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1726 SHAWANO AVE, GREEN BAY, WI 54303-3216
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3402-23
WI
363AS0400X
Surgical Physician Assistant
3204-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100039807
—
WI
Enumeration date
07/29/2014
Last updated
01/13/2026
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