Provider Demographics
NPI:1811997547
Name:GOODREAU, JAMES J (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:GOODREAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1259 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6206
Mailing Address - Country:US
Mailing Address - Phone:610-439-0372
Mailing Address - Fax:610-439-8807
Practice Address - Street 1:1259 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6206
Practice Address - Country:US
Practice Address - Phone:610-439-0372
Practice Address - Fax:610-439-8807
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025927E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA415832Medicare ID - Type Unspecified
PAC33689Medicare UPIN