Provider Demographics
NPI:1174506182
Name:GODCHAUX, JAMES BURTON SR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BURTON
Last Name:GODCHAUX
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 974150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-4150
Mailing Address - Country:US
Mailing Address - Phone:337-593-9500
Mailing Address - Fax:337-593-0909
Practice Address - Street 1:856 KALISTE SALOOM RD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4395
Practice Address - Country:US
Practice Address - Phone:337-593-9500
Practice Address - Fax:337-593-0909
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0119292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1164798Medicaid
5CK88Medicare ID - Type Unspecified
LA1164798Medicaid
LA4M368Medicare PIN