Individual
MR. CHARLES DANIEL GODFREY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
500 E VETERANS ST, TOMAH, WI 54660-3105
(608) 372-1798
Mailing address
PO BOX 116, TOMAH, WI 54660-0116
(608) 372-1798
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1441-023
WI
Other
Enumeration date
06/18/2006
Last updated
07/08/2007
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