Provider Demographics
NPI:1922092311
Name:GODCHAUX, JAMES B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:GODCHAUX
Suffix:JR
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 1:112 QUEEN OF PEACE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5383
Mailing Address - Country:US
Mailing Address - Phone:337-261-0786
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15349R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00327378OtherRAILROAD RETIREMENT MEDIC
LA1575437Medicaid
LA1575437Medicaid
LA4P373Medicare PIN
LAI05475Medicare UPIN
LA4F779CK88Medicare PIN
LA4F799Medicare PIN