Healthcare Provider Details

I. General information

NPI: 1144469792
Provider Name (Legal Business Name): CAULFIELD UROLOGY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 RUE DE SANTE SUITE 206
LA PLACE LA
70068-5424
US

IV. Provider business mailing address

502 RUE DE SANTE SUITE 206
LA PLACE LA
70068-5424
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-2638
  • Fax: 985-652-1491
Mailing address:
  • Phone: 985-652-2638
  • Fax: 985-652-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number12936R
License Number StateLA

VIII. Authorized Official

Name: DR. JOHN JUSTIN CAULFIELD
Title or Position: DOCTOR
Credential: M.D.
Phone: 985-652-2638