Provider Demographics
NPI:1184043275
Name:BUCKINGHAM, JOANNA CROSS-CALL (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:CROSS-CALL
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123
Mailing Address - Country:US
Mailing Address - Phone:504-738-1604
Mailing Address - Fax:504-738-7860
Practice Address - Street 1:9605 JEFFERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123
Practice Address - Country:US
Practice Address - Phone:504-738-1604
Practice Address - Fax:504-738-7860
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA304967208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program