Healthcare Provider Details

I. General information

NPI: 1164636395
Provider Name (Legal Business Name): JON F. MANJARRIS, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FLOURNOY RD
ALICE TX
78332-4085
US

IV. Provider business mailing address

14317 NORTHWEST BLVD SUITE A
CORPUS CHRISTI TX
78410-5536
US

V. Phone/Fax

Practice location:
  • Phone: 361-241-0324
  • Fax: 361-387-4153
Mailing address:
  • Phone: 361-241-0324
  • Fax: 361-387-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberF1772
License Number StateTX

VIII. Authorized Official

Name: JON F MANJARRIS
Title or Position: OWNER
Credential: M D
Phone: 361-241-0324