Provider Demographics
NPI:1295849495
Name:JUCAS, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:JUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4518
Mailing Address - Country:US
Mailing Address - Phone:870-862-5485
Mailing Address - Fax:870-863-5242
Practice Address - Street 1:525 W FAULKNER ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4518
Practice Address - Country:US
Practice Address - Phone:870-862-5485
Practice Address - Fax:870-863-5242
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR52777OtherBLUECROSS BLUESHIELD
AR710543368OtherTRICARE
AR14299000000OtherQUALCHOICE
AR106151001Medicaid
LA1911194Medicaid
LA24614OtherBLUECROSS BLUESHIELD
AR52777Medicare ID - Type Unspecified
LA1911194Medicaid