Healthcare Provider Details

I. General information

NPI: 1922092311
Provider Name (Legal Business Name): JAMES B. GODCHAUX JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 KALISTE SALOOM RD STE B
LAFAYETTE LA
70508-4395
US

IV. Provider business mailing address

112 QUEEN OF PEACE DR
LAFAYETTE LA
70508-5383
US

V. Phone/Fax

Practice location:
  • Phone: 337-593-9500
  • Fax:
Mailing address:
  • Phone: 337-261-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number15349R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: