Healthcare Provider Details

I. General information

NPI: 1932137049
Provider Name (Legal Business Name): MATTHEW ARTHUR MANNING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 FRANKLIN ST
KEOSAUQUA IA
52565-1164
US

IV. Provider business mailing address

304 FRANKLIN ST
KEOSAUQUA IA
52565-1164
US

V. Phone/Fax

Practice location:
  • Phone: 319-293-3171
  • Fax: 319-293-3473
Mailing address:
  • Phone: 319-293-3171
  • Fax: 319-293-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01707
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01707
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: