Provider Demographics
NPI:1730116716
Name:MCGAFF, CHARLES J JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:MCGAFF
Suffix:JR
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 1:1645 LUTCHER AVE
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-5150
Mailing Address - Country:US
Mailing Address - Phone:225-258-2080
Mailing Address - Fax:225-258-2081
Practice Address - Street 1:1645 LUTCHER AVE
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5150
Practice Address - Country:US
Practice Address - Phone:225-258-2080
Practice Address - Fax:225-258-2081
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015983208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900699Medicaid
364828ZJE5Medicare PIN
LA5N145Medicare ID - Type Unspecified