Individual
DR. ROBERT L GODDARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
817 W ROSEWOOD DR, BLOOMINGTON, IN 47404-1849
(812) 929-2952
Mailing address
817 W ROSEWOOD DR, BLOOMINGTON, IN 47404-1849
(812) 929-2952
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
01062280A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L3661
TEXAS LICENSE
TX
Enumeration date
05/22/2006
Last updated
03/07/2023
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