Basic Information
| Provider Information | |||||||||
| NPI: | 1184621948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODBOUT | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD STE 411 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD041621L | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0427799000 | 01 | AMERIHEALTH | OTHER | 1353362 | 01 | CIGNA HEALTHCARE | OTHER | 328815 | 01 | HEALTH AMERICA/HEALTH ASS | OTHER | 0427799000 | 01 | KEYSTONE HEALTH EAST | OTHER | 1459385 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 605276 | 01 | FIRST PRIORITY LIFE INS. | OTHER | 819550 | 01 | FIRST PRIORITY HEALTH | OTHER | 0012062330001 | 05 | PA | MEDICAID | 200007508 | 01 | RAILROAD MEDICARE | OTHER | 328815 | 01 | HIGHMARK BLUE SHIELD | OTHER | 01195901 | 01 | KEYSTONE HEALTH CENTRAL | OTHER | 088884 | 01 | AETNA | OTHER | 2170505 | 01 | MAMSI | OTHER | 0427799000 | 01 | INDEPENDENCE BLUE CROSS | OTHER | 50044348 | 01 | CAPITAL BLUE CROSS | OTHER | 13294 | 01 | GEISINGER HEALTH PLAN | OTHER | 1553795 | 01 | UNITED HEALTHCARE | OTHER | P379431 | 01 | OXFORD HEALTH PLANS | OTHER |