Provider Demographics
NPI:1902986854
Name:GODFREY, WILLIAM WALTER (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
Last Name:GODFREY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 INTERLACHEN CT
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6499
Mailing Address - Country:US
Mailing Address - Phone:915-373-9115
Mailing Address - Fax:
Practice Address - Street 1:333 INTERLACHEN CT
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-6499
Practice Address - Country:US
Practice Address - Phone:915-261-7897
Practice Address - Fax:915-261-7897
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1997213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAVAD000Medicare UPIN