Individual
DR. JONATHAN D GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1151 HOSPITAL WAY, BUILDING A, POCATELLO, ID 83201-5091
(208) 232-6616
(208) 232-6618
Mailing address
1151 HOSPITAL WAY, BUILDING A, POCATELLO, ID 83201-5091
(208) 232-6616
(208) 232-6618
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
2010012205
MO
207RG0100X
Gastroenterology Physician
Primary
M-11289
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/13/2007
Last updated
06/25/2013
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