Provider Demographics
NPI:1831120484
Name:GODREAU, ERIC M (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:GODREAU
Suffix:
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:PO BOX 491316
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-7316
Mailing Address - Country:US
Mailing Address - Phone:305-298-1333
Mailing Address - Fax:
Practice Address - Street 1:1380 NE MIAMI GARDENS DR
Practice Address - Street 2:#115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4707
Practice Address - Country:US
Practice Address - Phone:305-947-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME831342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263226800Medicaid
FL06306Medicare ID - Type Unspecified
FL263226800Medicaid