Healthcare Provider Details

I. General information

NPI: 1053221887
Provider Name (Legal Business Name): JOSIAH JAMES CAGLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SAINT JOHNS BLVD
JOPLIN MO
64804-1598
US

IV. Provider business mailing address

20551 MOUNTAIN VISTA DR
EAGLE RIVER AK
99577-8873
US

V. Phone/Fax

Practice location:
  • Phone: 417-208-0630
  • Fax:
Mailing address:
  • Phone: 580-747-7917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: