Provider Demographics
NPI:1962729640
Name:ALAN W. MANNING M.D., A PROFESSIONAL CORP
Entity type:Organization
Organization Name:ALAN W. MANNING M.D., A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-542-6444
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1515
Mailing Address - Country:US
Mailing Address - Phone:985-542-6444
Mailing Address - Fax:985-542-6445
Practice Address - Street 1:15715 PROFESSIONAL PLAZA
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0000
Practice Address - Country:US
Practice Address - Phone:985-542-6444
Practice Address - Fax:985-542-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1321524Medicaid