Provider Demographics
NPI:1235315524
Name:JOHN B. CAZALE, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOHN B. CAZALE, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAZALE
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:504-885-8225
Mailing Address - Street 1:4720 S I 10 SERVICE RD W
Mailing Address - Street 2:SUITE 301
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7404
Mailing Address - Country:US
Mailing Address - Phone:504-885-8225
Mailing Address - Fax:504-885-7642
Practice Address - Street 1:4720 S I 10 SERVICE RD W
Practice Address - Street 2:SUITE 301
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7404
Practice Address - Country:US
Practice Address - Phone:504-885-8225
Practice Address - Fax:504-885-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012260207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1317985Medicaid
LADH0316OtherMEDICARE RR
LAH9388OtherBLUE CROSS BLUE SHIELD
173372600OtherDOL
LA5B417Medicare PIN