Provider Demographics
NPI:1922289396
Name:LANDES, JOSHUA SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:SCOTT
Last Name:LANDES
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 1:4809 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6917
Mailing Address - Country:US
Mailing Address - Phone:337-988-8880
Mailing Address - Fax:337-988-8883
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6917
Practice Address - Country:US
Practice Address - Phone:337-988-8880
Practice Address - Fax:337-988-8883
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200696208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1061476Medicaid
LAP00654908OtherPALMETTO GBA - RAILROAD MEDICARE
LA1061476Medicaid
LA4N269Medicare PIN