Provider Demographics
NPI:1285637645
Name:JOSEPH, JONATHAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:214 SOUTHCITY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5718
Mailing Address - Country:US
Mailing Address - Phone:337-981-6430
Mailing Address - Fax:337-981-9134
Practice Address - Street 1:214 SOUTHCITY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5718
Practice Address - Country:US
Practice Address - Phone:337-981-6430
Practice Address - Fax:337-981-9134
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-08-08
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Provider Licenses
StateLicense IDTaxonomies
LA017696207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1285637645OtherPHCS
LA1285637645OtherUNITED HEALTHCARE
LA1285637645OtherST. EMPLOYEES GROUP
LA1285637645OtherBLUE CROSS & BLUE SHIELD
LA1285637645OtherVERITY
LA1285637645OtherPPO PLUS
LA1285637645OtherAMERICAN LIFECARE
LA1285637645OtherCOVENTRY
LA1285637645OtherBESTCARE
LA1285637645OtherGILSBAR 360
LA1285637645OtherBESTCARE
LA1285637645OtherUNITED HEALTHCARE
LA1285637645Medicare PIN
LA1285637645OtherPPO PLUS
LA1285637645OtherCOVENTRY