Basic Information
| Provider Information | |||||||||
| NPI: | 1003392457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CADY | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 TEMPLE AVE | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832013427 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860043708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287197400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2018 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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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 | 213EP1101X | POD-000908 | AZ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ER0200X | POD-000908 | AZ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology | 213ES0000X | POD-000908 | AZ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 213ES0131X | POD-000908 | AZ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213E00000X | POD-000908 | AZ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.