Provider Demographics
NPI:1659575215
Name:DANNA, SAMUEL COLBY (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:COLBY
Last Name:DANNA
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 1:2820 NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6969
Mailing Address - Country:US
Mailing Address - Phone:504-842-4960
Mailing Address - Fax:
Practice Address - Street 1:1415 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2426
Practice Address - Country:US
Practice Address - Phone:504-842-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1297207R00000X
LAMD.205314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B2654OtherBCBS
MS07352719Medicaid
LA2306375Medicaid
TX203474601Medicaid
3864783177OtherMYUTMB 3864783177-COMMERCIAL NUMBER
TX203474602Medicaid
TX8CU122OtherBCBS
MS07352719Medicaid
LA248695YH3UMedicare PIN
3864783177OtherMYUTMB 3864783177-COMMERCIAL NUMBER