Basic Information
| Provider Information | |||||||||
| NPI: | 1447274741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GODKE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8585 PICARDY AVE SUITE 313 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256356916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5825 AIRLINE HWY | ||||||||
| Address2: | EKL HOSPITAL | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812755 | ||||||||
| FaxNumber: | 2253812759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | MD.025376 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | MD.025376 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1575445 | 05 | LA | MEDICAID |