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Individual

GEORGE EMIL GODDRIDGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
7777 GRANDE ST, SUNRISE, FL 33351-6313
(954) 547-2675
Mailing address
7777 GRANDE ST, SUNRISE, FL 33351-6313
(954) 547-2675

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
JF130454
FL

Other

Enumeration date
07/25/2019
Last updated
07/25/2019
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