Provider Demographics
NPI:1336132315
Name:JOSEPH, JEFFREY J (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 W PINHOOK RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2464
Mailing Address - Country:US
Mailing Address - Phone:337-237-0650
Mailing Address - Fax:337-237-1086
Practice Address - Street 1:1000 W PINHOOK RD
Practice Address - Street 2:STE 201
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2464
Practice Address - Country:US
Practice Address - Phone:337-237-0650
Practice Address - Fax:888-990-2781
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2020-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAL019073207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA040017313OtherRAILROAD MEDICARE
LA1443727Medicaid
LA1443727Medicaid
F55777Medicare UPIN