Healthcare Provider Details

I. General information

NPI: 1255751707
Provider Name (Legal Business Name): TERESA MANN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 09/01/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W KAGY BLVD STE 2
BOZEMAN MT
59718-5938
US

IV. Provider business mailing address

2233 W KAGY BLVD STE 2
BOZEMAN MT
59718-5938
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-7873
  • Fax: 406-586-2332
Mailing address:
  • Phone: 406-586-7873
  • Fax: 406-586-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TERESA P. MANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 406-586-7873