Provider Demographics
NPI:1487602793
Name:HANEMANN, JAMES DOUGLASS (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLASS
Last Name:HANEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE N108
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3152
Mailing Address - Country:US
Mailing Address - Phone:504-349-1461
Mailing Address - Fax:504-349-1461
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:STE. N-108
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-1461
Practice Address - Fax:504-349-1461
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0242222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04375217Medicaid
LA1572489Medicaid
I06893Medicare UPIN
LA1572489Medicaid