Provider Demographics
NPI:1528040540
Name:MCCABE, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:MCCABE
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 1:301 4TH ST
Mailing Address - Street 2:BOX 30150
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8423
Mailing Address - Country:US
Mailing Address - Phone:318-445-9306
Mailing Address - Fax:318-445-9307
Practice Address - Street 1:301 4TH ST
Practice Address - Street 2:BOX 30150
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8423
Practice Address - Country:US
Practice Address - Phone:318-445-9306
Practice Address - Fax:318-445-9307
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05196R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1359262Medicaid
240007470Medicare PIN
LAB42878Medicare UPIN
LA52033Medicare PIN