Healthcare Provider Details

I. General information

NPI: 1225377856
Provider Name (Legal Business Name): JAMES J LANASA JR MD PMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 QUAIL RUN DR. STE E
BATON ROUGE LA
70808
US

IV. Provider business mailing address

2223 QUAIL RUN DR. STE E
BATON ROUGE LA
70808
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-7560
  • Fax: 225-769-7500
Mailing address:
  • Phone: 225-769-7560
  • Fax: 225-769-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number010498
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number010498
License Number StateLA

VIII. Authorized Official

Name: DR. JAMES J LANASA JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 225-769-7560