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NPI Code Detail

MEDICARE: MR. JOHN TRUMAN FANNING PH.D

MEDICARE: MR. JOHN TRUMAN FANNING PH.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist468LA
2103TC0700XClinical Psychologist468LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508072216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN TRUMAN FANNING PH.D
Provider Business Mailing Address
First Line : 715 PECAN GROVE LN
Second Line :
City : JEFFERSON
State : LA
Zip : 70121-1130
Country : US
Telephone Number : 504-421-0730
Fax Number : 888-959-6762
Provider Business Practice Location Address
First Line : 4440 CANAL STREET
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70119-6021
Country : US
Telephone Number : 504-421-0730
Fax Number : 888-959-6762
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 10/03/2016

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