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NPI Code Detail

MEDICARE: DR. THOMAS MARTIN MANNING MD

MEDICARE: DR. THOMAS MARTIN MANNING 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
1207Q00000XFamily Medicine Physician13774OR

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 : 1518964600
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS MARTIN MANNING MD
Provider Business Mailing Address
First Line : 76 NE 12TH ST
Second Line :
City : MADRAS
State : OR
Zip : 97741-1827
Country : US
Telephone Number : 541-475-3874
Fax Number : 541-475-3503
Provider Business Practice Location Address
First Line : 76 NE 12TH ST
Second Line :
City : MADRAS
State : OR
Zip : 97741-1827
Country : US
Telephone Number : 541-475-3874
Fax Number : 541-475-3503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 03/28/2017

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Directions to “ DR. THOMAS MARTIN MANNING MD” Practice Location

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