Individual
DR. DANIEL G GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9679 LAKE NONA VILLAGE PL STE 101, ORLANDO, FL 32827-7310
(407) 826-1895
(321) 203-4601
Mailing address
9679 LAKE NONA VILLAGE PL STE 101, ORLANDO, FL 32827-7310
(407) 826-1895
(321) 203-4601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME61279
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D1007057
C.L.I.A. #
FL
01
—
28143
BLUE CROSS BLUE SHIELD
FL
05
—
378940300
—
FL
01
—
51801387
AETNA PROVIDER #
FL
01
—
593582765
GOLDEN RULE PROVIDER #
FL
01
—
BD4403161
D.E.A. #
FL
01
—
ME61279
FLORIDA STATE LICENSE #
FL
Enumeration date
09/28/2006
Last updated
05/20/2020
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