Provider Demographics
NPI:1780651042
Name:MASS, JOSEPH LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LAWRENCE
Last Name:MASS
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 1:303 VETERANS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4722
Mailing Address - Country:US
Mailing Address - Phone:225-665-7785
Mailing Address - Fax:225-664-4623
Practice Address - Street 1:303 VETERANS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4722
Practice Address - Country:US
Practice Address - Phone:225-665-7785
Practice Address - Fax:225-664-4623
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1307793Medicaid
LA53455Medicare ID - Type Unspecified
LA53455C822Medicare PIN
LA1307793Medicaid