Individual
JOHN GORDON GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1666 E BERT KOUNS INDUSTRIAL LOOP, SUITE 105, SHREVEPORT, LA 71105-5714
(318) 212-3750
(318) 212-3755
Mailing address
1666 E BERT KOUNS INDUSTRIAL LOOP, SUITE 105, SHREVEPORT, LA 71105-5714
(318) 212-3750
(318) 212-3755
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101057937
VA
207Q00000X
Family Medicine Physician
Primary
15478R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1466760
—
LA
Enumeration date
07/03/2006
Last updated
10/31/2007
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