Provider Demographics
NPI:1730278375
Name:GODDARD, JOHN CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:GODDARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10180 SE SUNNYSIDE RD
Mailing Address - Street 2:SUNNYBROOK MEDICAL BUILDING, DEPT OF OTOLARYNGOLOGY
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8970
Mailing Address - Country:US
Mailing Address - Phone:503-571-3495
Mailing Address - Fax:503-571-9004
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:SUNNYBROOK MEDICAL BUILDING, DEPT OF OTOLARYNGOLOGY
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-571-3495
Practice Address - Fax:503-571-9004
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 109697207YX0901X
CAA107625207YX0901X
ORMD166617207YX0901X, 207Y00000X
WAMD 60454681207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology