Provider Demographics
NPI:1790788842
Name:MCMANUS, LAWRENCE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JAMES
Last Name:MCMANUS
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 1:319 MEMPHIS ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3845
Mailing Address - Country:US
Mailing Address - Phone:985-646-0945
Mailing Address - Fax:985-643-8510
Practice Address - Street 1:1520 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-646-0945
Practice Address - Fax:985-643-8510
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-01-22
Deactivation Date:2005-05-23
Deactivation Code:
Reactivation Date:2005-05-24
Provider Licenses
StateLicense IDTaxonomies
LA009948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1102482Medicaid
LA1102482Medicaid
LA4E671Medicare ID - Type Unspecified
LAB64708Medicare UPIN