Basic Information
| Provider Information | |||||||||
| NPI: | 1710001565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODOY | ||||||||
| FirstName: | GENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 IVES DAIRY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331792425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054050365 | ||||||||
| FaxNumber: | 3054050370 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 IVES DAIRY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331792425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054050365 | ||||||||
| FaxNumber: | 3054050370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 06/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0065758 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 376822800 | 05 | FL | MEDICAID | ME0065758 | 01 | FL | LICENSE NUMBER | OTHER | 26390X | 01 | MEDICARE ID | OTHER |