Provider Demographics
NPI:1386695708
Name:GODERSKY, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:GODERSKY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3831 PIPER ST
Mailing Address - Street 2:SUITE S-220
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4672
Mailing Address - Country:US
Mailing Address - Phone:907-258-6999
Mailing Address - Fax:907-258-6247
Practice Address - Street 1:3831 PIPER ST
Practice Address - Street 2:SUITE S-220
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4672
Practice Address - Country:US
Practice Address - Phone:907-258-6999
Practice Address - Fax:907-258-6247
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-01-13
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Provider Licenses
StateLicense IDTaxonomies
AK2484207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKA01994Medicare UPIN