Individual
LACEY MATHILDA GODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1202 S TYLER ST, COVINGTON, LA 70433-2330
(985) 892-3225
(985) 892-7677
Mailing address
120 INNWOOD DR, COVINGTON, LA 70433-9123
(985) 892-3225
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
205372
LA
207L00000X
Anesthesiology Physician
LL30817
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08471706
—
MS
05
—
2304402
—
LA
Enumeration date
07/04/2008
Last updated
12/20/2016
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