Healthcare Provider Details

I. General information

NPI: 1073861837
Provider Name (Legal Business Name): JOSHUA R CASON LIMITED APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 RINGGOLD AVE SUITE B
COUSHATTA LA
71019-9073
US

IV. Provider business mailing address

PO BOX 53032
SHREVEPORT LA
71135-3032
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-2081
  • Fax: 318-932-2215
Mailing address:
  • Phone: 318-932-2081
  • Fax: 318-932-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204298
License Number StateLA

VIII. Authorized Official

Name: DR. JOSHUA RAY CASON
Title or Position: MD/OWNER
Credential: MD
Phone: 318-423-4385