Provider Demographics
NPI:1538198213
Name:GODBOUT, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:GODBOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 KEISLER DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7069
Mailing Address - Country:US
Mailing Address - Phone:919-781-9950
Mailing Address - Fax:919-783-9950
Practice Address - Street 1:400 KEISLER DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7069
Practice Address - Country:US
Practice Address - Phone:919-781-9950
Practice Address - Fax:919-783-9950
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300791208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2300424OtherUHC
NC89134PNMedicaid
3412942OtherCIGNA
NCC6678OtherMEDCOST
NC134PNOtherBCBSNC
NCP00036371Medicare PIN
NC2300424OtherUHC
NC89134PNMedicaid