Jerry L Goddard in Carbondale - Sports Medicine
Jerry L Goddard - NPI 1295711240
Jerry L Goddard is a Sports Medicine in Carbondale, Illinois. Jerry L Goddard practices all healthcare services and medical treatments related to Sports Medicine. The NPI Number for Jerry L Goddard is 1295711240. The last update date is 2020-12-28.
Jerry L Goddard's current location address is 305 W Jackson St, Carbondale, Illinois. You can contact this provider via phone number 6185366621 and fax number 6184531102. The mailing address for Jerry L Goddard is 305 W Jackson St, Carbondale, Illinois. To know further, please read the information below!
Provider Profile Detail
Provider Name | Jerry L Goddard |
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Address | 305 W Jackson St, Carbondale, Illinois |
Phone Number | 6185366621 |
Fax Number | 6184531102 |
Sole Proprietor | N |
Credentials | M.D. |
NPI Number Detail
NPI Number | 1295711240 |
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Provider Enumeration Date | 2005-12-21 |
Last Updated Date | 2020-12-28 |
Provider Mailing Address Detail
Address | 305 W Jackson St |
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City | Carbondale |
State | Illinois (IL) |
Post Code | 629011474 |
Phone Number | 6185366621 |
Fax Number | 6184531102 |
Provider's Primary Taxonomy Detail
Speciality | Sports Medicine |
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Taxonomy | 207Qs0010X |
Licence No | 036-054846 |
Definition: A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must |
Provider's Other Legacy Identifiers
Identifier | Identifier Type | Identifier State | Identifier Issuer |
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36054846 | IL | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Jerry L Goddard by the Centers for Medicare & Medicaid Services?
The Jerry L Goddard has been assigned the NPI (National Provider Identifier) 1295711240. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you please share the complete physical location address where Jerry L Goddard's facilities are situated?
The facilities of Jerry L Goddard are physically located at the following address: 305 W Jackson St, Carbondale, IL, 629011474.
What is the Jerry L Goddard's area of specialization and corresponding taxonomy classification?
The Jerry L Goddard's specialty field is Sports Medicine, and it falls under the taxonomy code 207Qs0010X, which categorizes healthcare providers based on their specialties.
On what date did Jerry L Goddard receive its 1295711240 assignment from the Centers for Medicare & Medicaid Services?
The Jerry L Goddard was assigned its 1295711240 on 2005-12-21, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
When was the information regarding Jerry L Goddard most recently updated?
The details pertaining to the Jerry L Goddard, including its address, specialty, and other relevant information, were last refreshed on 2020-12-28.