Healthcare Provider Details

I. General information

NPI: 1861688434
Provider Name (Legal Business Name): RONALD M. MANN, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 E PIMA ST SUITE I
TUCSON AZ
85712-5601
US

IV. Provider business mailing address

5700 E PIMA ST SUITE I
TUCSON AZ
85712-5601
US

V. Phone/Fax

Practice location:
  • Phone: 520-529-8883
  • Fax: 520-290-0039
Mailing address:
  • Phone: 520-529-8883
  • Fax: 520-290-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number31923
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number31923
License Number StateAZ

VIII. Authorized Official

Name: RONALD MAYNARD MANN
Title or Position: MANAGER
Credential:
Phone: 520-529-8883