Healthcare Provider Details

I. General information

NPI: 1003392457
Provider Name (Legal Business Name): JOSHUA THOMAS CADY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N 4TH ST
FLAGSTAFF AZ
86004-3708
US

IV. Provider business mailing address

13 TEMPLE AVE
POCATELLO ID
83201-3427
US

V. Phone/Fax

Practice location:
  • Phone: 928-719-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-000908
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD-000908
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPOD-000908
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPOD-000908
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD-000908
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: