Provider Demographics
NPI:1144469792
Name:CAULFIELD UROLOGY CENTERS
Entity type:Organization
Organization Name:CAULFIELD UROLOGY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:CAULFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-652-2638
Mailing Address - Street 1:502 RUE DE SANTE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5424
Mailing Address - Country:US
Mailing Address - Phone:985-652-2638
Mailing Address - Fax:985-652-1491
Practice Address - Street 1:502 RUE DE SANTE
Practice Address - Street 2:SUITE 206
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5424
Practice Address - Country:US
Practice Address - Phone:985-652-2638
Practice Address - Fax:985-652-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12936R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1553140Medicaid
LA5E346Medicare UPIN