Basic Information
| Provider Information | |||||||||
| NPI: | 1659575215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANNA | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | COLBY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2820 NAPOLEON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701156969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1415 JEFFERSON HWY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701212426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N1297 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD.205314 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8B2654 | 01 | TX | BCBS | OTHER | 07352719 | 05 | MS | MEDICAID | 2306375 | 05 | LA | MEDICAID | 203474601 | 05 | TX | MEDICAID | 3864783177 | 01 | MYUTMB 3864783177-COMMERCIAL NUMBER | OTHER | 203474602 | 05 | TX | MEDICAID | 8CU122 | 01 | TX | BCBS | OTHER |