Provider Demographics
NPI:1033390133
Name:LANNON, JAMES B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:LANNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1151
Mailing Address - Country:US
Mailing Address - Phone:651-699-0762
Mailing Address - Fax:
Practice Address - Street 1:2183 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1151
Practice Address - Country:US
Practice Address - Phone:651-699-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist