Individual
ROBERT W GODLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11108 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1730
(260) 266-5700
(260) 266-5920
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01026671A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000641082
ANTHEM
IN
05
—
0528021
—
OH
01
—
060070590
RR MEDICARE
IN
05
—
100054710
—
IN
Enumeration date
08/15/2005
Last updated
10/14/2022
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