Provider Demographics
NPI:1104842814
Name:LACAVA, JOSEPH M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:LACAVA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 CENTRAL AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6138
Mailing Address - Country:US
Mailing Address - Phone:501-321-4844
Mailing Address - Fax:501-321-0956
Practice Address - Street 1:3339 CENTRAL AVE
Practice Address - Street 2:SUITE F
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6138
Practice Address - Country:US
Practice Address - Phone:501-321-4844
Practice Address - Fax:501-321-0956
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5369540001OtherMEDICARE NSC
AR5X274OtherBLUE CROSS BLUE SHIELD
AR149217717Medicaid
ARP00299513OtherRAILROAD
AR14917717Medicaid
AR57-1205028OtherTIN
AR5369540001OtherMEDICARE NSC
AR14917717Medicaid