Provider Demographics
NPI:1114366812
Name:IMMS, JOHN B (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:IMMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3600 PRYTANIA ST STE 35
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3678
Mailing Address - Country:US
Mailing Address - Phone:504-897-8412
Mailing Address - Fax:504-249-5311
Practice Address - Street 1:1401 FOUCHER ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3515
Practice Address - Country:US
Practice Address - Phone:504-210-4472
Practice Address - Fax:504-210-4473
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2023-02-06
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Provider Licenses
StateLicense IDTaxonomies
LA303822208M00000X, 207P00000X, 207Q00000X, 207R00000X
PAMT204691390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT204691OtherGRADUATE MEDICAL TRAINEE
LA2439012Medicaid