Individual
AMANDA VIOLET GRIPPEN GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7001 SIGNAL AVE NE, ALBUQUERQUE, NM 87113-2453
(505) 826-2735
(505) 856-2749
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
A233920
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1D3719
MEDICARE PTAN
NM
01
—
1D3721
MEDICARE PTAN
NM
05
—
38337207
—
NM
Enumeration date
05/27/2014
Last updated
10/30/2023
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