Provider Demographics
NPI:1861418931
Name:GODINICH, MARY JOSEPHINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOSEPHINE
Last Name:GODINICH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8900 EMMETT F LOWRY EXPY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-9119
Mailing Address - Country:US
Mailing Address - Phone:409-933-0555
Mailing Address - Fax:409-935-9238
Practice Address - Street 1:8900 EMMETT F LOWRY EXPY
Practice Address - Street 2:SUITE 200
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-9119
Practice Address - Country:US
Practice Address - Phone:409-933-0555
Practice Address - Fax:409-935-9238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH3316207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132100205Medicaid
TX00U53WMedicare ID - Type Unspecified
E95899Medicare UPIN