MEDICARE: DR. JOSHUA CALEB MANDRELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD.204800	LA

General Provider Information

NPI Number	:	1770781650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA CALEB MANDRELL M.D.

Provider Business Mailing Address
First Line	:	911 TECH DR
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-0701
Country	:	US
Telephone Number	:	318-265-6376
Fax Number	:	318-265-6377

Provider Business Practice Location Address
First Line	:	911 TECH DR
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-0701
Country	:	US
Telephone Number	:	318-265-6376
Fax Number	:	318-265-6377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	01/21/2026

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