Healthcare Provider Details

I. General information

NPI: 1891895017
Provider Name (Legal Business Name): FINN MANNTING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

8241 SUMMA AVE SUITE D
BATON ROUGE LA
70809-3422
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-8995
  • Fax: 225-765-1299
Mailing address:
  • Phone: 225-796-9797
  • Fax: 225-769-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number14176R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number17479
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: