Provider Demographics
NPI:1023014313
Name:LANNAN, MAUREEN ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:ROSE
Last Name:LANNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 LA PAIX DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-9369
Mailing Address - Country:US
Mailing Address - Phone:337-583-9530
Mailing Address - Fax:337-528-2749
Practice Address - Street 1:622 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5052
Practice Address - Country:US
Practice Address - Phone:337-527-2491
Practice Address - Fax:337-528-2749
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10386R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1999857Medicaid
LA5481980001Medicare NSC
LA1999857Medicaid
LA5U849CN19Medicare PIN