Basic Information
| Provider Information | |||||||||
| NPI: | 1922092311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODCHAUX | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 QUEEN OF PEACE DR | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705085383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372610786 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 856 KALISTE SALOOM RD STE B | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705084395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375939500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 01/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 15349R | LA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00327378 | 01 | LA | RAILROAD RETIREMENT MEDIC | OTHER | 1575437 | 05 | LA | MEDICAID |