MEDICARE: DR. ROGER CHARLES MANN M.D.

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	173000000X	Legal Medicine	31281	CO
2	207Q00000X	Family Medicine Physician	31281	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568441269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER CHARLES MANN M.D.

Provider Business Mailing Address
First Line	:	1619 N GREENWOOD ST
Second Line	:	SUITE 208
City	:	PUEBLO
State	:	CO
Zip	:	81003-2644
Country	:	US
Telephone Number	:	719-561-4336
Fax Number	:	719-561-8469

Provider Business Practice Location Address
First Line	:	1619 N GREENWOOD ST
Second Line	:	SUITE 208
City	:	PUEBLO
State	:	CO
Zip	:	81003-2644
Country	:	US
Telephone Number	:	719-561-4336
Fax Number	:	719-561-8469

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/31/2019

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