Provider Demographics
NPI:1316758998
Name:MARK J GODAT MD PA
Entity type:Organization
Organization Name:MARK J GODAT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:GODAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-893-8065
Mailing Address - Street 1:7009 LAKE EDGE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2368
Mailing Address - Country:US
Mailing Address - Phone:214-893-8065
Mailing Address - Fax:214-696-9483
Practice Address - Street 1:12201 MERIT DR STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3117
Practice Address - Country:US
Practice Address - Phone:469-840-4888
Practice Address - Fax:469-840-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134281405OtherOBSTETRICS AND GYNECOLOBY
TX1275198988OtherOBSTETRICS AND GYNECOLOGY