Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 12314R | LA |
NPI | 1043201569 |
---|---|
Provider Name | Dr. James Jeffery Jancuska |
First Address | New Orleans, LA 70121-2429 |
Second Address | Lake Charles, LA 70601-5864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 05/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1533041 | (05) | LA |
1900212 | UNITED HEALTHCARE (01) | LA |
340014317 | RAILROAD MEDICARE (01) | LA |
G53350 | (02) | LA |