MEDICARE: TERESITA I MANUBAY MD

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
1	208000000X	Pediatrics Physician	MDR6794	MO

General Provider Information

NPI Number	:	1235132648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESITA I MANUBAY MD

Provider Business Mailing Address
First Line	:	1312 1ST ST
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-2526
Country	:	US
Telephone Number	:	573-888-1224
Fax Number	:	573-888-3046

Provider Business Practice Location Address
First Line	:	1312 1ST ST
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-2526
Country	:	US
Telephone Number	:	573-888-1224
Fax Number	:	573-888-3046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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Directions to “ TERESITA I MANUBAY MD” Practice Location

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