Provider Demographics
NPI:1194761882
Name:GODFREY, DAVID GRAY (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GRAY
Last Name:GODFREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10740 N CENTRAL EXPY
Mailing Address - Street 2:STE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2168
Mailing Address - Country:US
Mailing Address - Phone:214-360-0000
Mailing Address - Fax:214-360-0083
Practice Address - Street 1:10740 N CENTRAL EXPY
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2161
Practice Address - Country:US
Practice Address - Phone:214-360-0000
Practice Address - Fax:214-360-0083
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8174207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W9930OtherBCBS
TX04719970 04Medicaid
TX8W9930OtherBCBS
TXG90352Medicare UPIN
TXP00367104Medicare PIN