Provider Demographics
NPI:1447274741
Name:GODKE, JOHN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:GODKE
Suffix:
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 1:8585 PICARDY AVE SUITE 313
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-635-6916
Mailing Address - Fax:
Practice Address - Street 1:5825 AIRLINE HWY
Practice Address - Street 2:EKL HOSPITAL
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805
Practice Address - Country:US
Practice Address - Phone:225-381-2755
Practice Address - Fax:225-381-2759
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025376207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1575445Medicaid
LA1575445Medicaid