Individual
WILLARD KENNETH MANN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
5500 PRYTANIA ST # 235, NEW ORLEANS, LA 70115-4221
(504) 867-2200
(800) 619-0163
Mailing address
5500 PRYTANIA STREET, PMB235, NEW ORLEANS, LA 70115-4221
(504) 867-2200
(800) 619-0163
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD.018257
LA
208600000X
Surgery Physician
018257
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03328769
—
MS
05
—
1367575
—
LA
Enumeration date
08/19/2006
Last updated
04/12/2023
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