Healthcare Provider Details

I. General information

NPI: 1285959031
Provider Name (Legal Business Name): MR. GODDY E ORGOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3032 JACKSON ST
ALEXANDRIA LA
71301-4743
US

IV. Provider business mailing address

3032 JACKSON ST
ALEXANDRIA LA
71301-4743
US

V. Phone/Fax

Practice location:
  • Phone: 713-446-6221
  • Fax: 713-893-6018
Mailing address:
  • Phone: 713-446-6221
  • Fax: 713-893-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number554000
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: