Provider Demographics
NPI:1619035706
Name:LEONARD P. NEUMANN JR MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LEONARD P. NEUMANN JR MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-574-4731
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71284-0309
Mailing Address - Country:US
Mailing Address - Phone:318-574-4731
Mailing Address - Fax:318-574-4739
Practice Address - Street 1:800 JOHNSON ST.
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4235
Practice Address - Country:US
Practice Address - Phone:318-574-4731
Practice Address - Fax:318-574-4739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4336215270OtherBLUE CROSS OF LA
827113052OtherPALMETTO GBA RAILROAD MED
1198579OtherMEDICAID INDIVIDUAL
54420OtherMEDICARE INDIVIDUAL
LA1948497Medicaid
1198579OtherMEDICAID INDIVIDUAL
4336215270OtherBLUE CROSS OF LA