=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992845127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHON JAY RYNNING M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 10/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 HOUMA BLVD STE 401
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-889-1448
-----------------------------------------------------
Fax | 504-889-1452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3901 HOUMA BLVD STE 401
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-889-1448
-----------------------------------------------------
Fax | 504-885-8752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 07800R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------