Provider Demographics
NPI:1295849495
Name:JUCAS, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:JUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:JOHN J. JUCAS M.D.
Mailing Address - Street 2:6121 FERN AVE UNIT 107
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-617-3667
Mailing Address - Fax:870-863-5242
Practice Address - Street 1:JOHN J. JUCAS M.D.
Practice Address - Street 2:6121 FERN AVE UNIT 107
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-617-3667
Practice Address - Fax:870-863-5242
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206362207N00000X
ARC4839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA24614OtherBLUECROSS BLUESHIELD
LA1911194Medicaid
AR106151001Medicaid
AR14299000000OtherQUALCHOICE
AR52777OtherBLUECROSS BLUESHIELD
AR710543368OtherTRICARE
AR52777Medicare ID - Type Unspecified
LA1911194Medicaid