Provider Demographics
NPI:1124113790
Name:BROWN-MANNING, CYNTHIA LOUISA (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LOUISA
Last Name:BROWN-MANNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 KIOWA ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8564
Mailing Address - Country:US
Mailing Address - Phone:318-348-2696
Mailing Address - Fax:
Practice Address - Street 1:4864 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6400
Practice Address - Country:US
Practice Address - Phone:318-330-7600
Practice Address - Fax:318-330-7649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1493848Medicaid
LA72-1507808OtherTIN
LA72-1507808OtherTIN
LA5E462Medicare PIN
LA5E462DJ97Medicare PIN