Marvin Jordan Godner, M.D.
Individual provider Active NPI Pediatrics Physician · San Felipe Pueblo, NM
NPI 1164439261 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164439261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 75-38 (NM)
- Practice address
- 711 Pueblo Main Street
San Felipe Pueblo, NM 87001 - Phone
- (505) 867-3365
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 75-38 | NM | Yes |
Addresses
Primary practice location
711 Pueblo Main Street
San Felipe Pueblo, NM 87001
Mailing address
2313 Calle Colibri
Santa Fe, NM 87505-6301
Phone (505) 983-0507
Other providers in San Felipe Pueblo, NM
- Tana Chavez
- Timothy Earle Moeslein
- Carlos Vallejo Sedillo
- Dana Shock
- Iris Ann Toribio
- Darlene J Valencia
All providers in San Felipe Pueblo, NM · Pediatrics Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.