Provider Demographics
NPI:1902900335
Name:GODDER, KAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAR
Middle Name:
Last Name:GODDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 PONCE DE LEON BLVD.
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-661-1515
Mailing Address - Fax:305-662-3723
Practice Address - Street 1:3100 S.W. 62ND AVENUE, SUITE #121
Practice Address - Street 2:NORTH EAST WING
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-662-8360
Practice Address - Fax:305-666-6387
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237615208000000X, 2080P0207X
FLME1172142080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010158991Medicaid
F42928Medicare UPIN
VA010158991Medicaid