Provider Demographics
NPI:1508858937
Name:DANNA, LAWRENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:DANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:J
Other - Last Name:DANNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:108 CONTEMPO AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5312
Mailing Address - Country:US
Mailing Address - Phone:318-388-4994
Mailing Address - Fax:318-325-8303
Practice Address - Street 1:108 CONTEMPO AVE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5312
Practice Address - Country:US
Practice Address - Phone:318-388-4994
Practice Address - Fax:318-325-8303
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011617207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158208Medicaid
LA1158208Medicaid
B63346Medicare UPIN