Basic Information
| Provider Information | |||||||||
| NPI: | 1073861837 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOSHUA R CASON LIMITED APMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 53032 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711353032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189322081 | ||||||||
| FaxNumber: | 3189322215 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 RINGGOLD AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | COUSHATTA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710199073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189322081 | ||||||||
| FaxNumber: | 3189322215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 01/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | CASON | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3184234385 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 204298 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2140086 | 05 | LA | MEDICAID | DU2283 | 01 | LA | RR MEDICARE GROUP | OTHER |