Provider Demographics
NPI:1578775417
Name:LAWRENCE J. DANNA, MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LAWRENCE J. DANNA, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-388-4994
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.011617207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158208Medicaid
LA1158208Medicaid
LAB63346Medicare UPIN