1295849495 NPI number — DR. JOHN J JUCAS M.D.

Table of content: DR. JOHN J JUCAS M.D. (NPI 1295849495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295849495 NPI number — DR. JOHN J JUCAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUCAS
Provider First Name:
JOHN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295849495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
JOHN J. JUCAS M.D.
Provider Second Line Business Mailing Address:
6121 FERN AVE UNIT 107
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-617-3667
Provider Business Mailing Address Fax Number:
870-863-5242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JOHN J. JUCAS M.D.
Provider Second Line Business Practice Location Address:
6121 FERN AVE UNIT 107
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-617-3667
Provider Business Practice Location Address Fax Number:
870-863-5242
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD.206362 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: C4839 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24614 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1911194 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106151001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14299000000 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 52777 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 710543368 . This is a "TRICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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