Individual
MR. JOSHUA SQUARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
69 6TH AVE, SHALIMAR, FL 32579-1966
(504) 281-5498
Mailing address
69 6TH AVE, SHALIMAR, FL 32579-1966
(504) 281-5498
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
FL
Other
Enumeration date
10/09/2019
Last updated
10/09/2019
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