Healthcare Provider Details

I. General information

NPI: 1841931698
Provider Name (Legal Business Name): JON MANGELS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8166 MAIN ST
HOUMA LA
70360-3404
US

IV. Provider business mailing address

8166 MAIN ST
HOUMA LA
70360-3404
US

V. Phone/Fax

Practice location:
  • Phone: 985-873-4141
  • Fax:
Mailing address:
  • Phone: 985-873-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number352567
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: