Healthcare Provider Details

I. General information

NPI: 1326048059
Provider Name (Legal Business Name): MELVIN R MANNING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SNIDER PLZ #200
DALLAS TX
75205-5648
US

IV. Provider business mailing address

6901 SNIDER PLZ #200
DALLAS TX
75205-5648
US

V. Phone/Fax

Practice location:
  • Phone: 214-369-7733
  • Fax: 214-369-7739
Mailing address:
  • Phone: 214-369-7733
  • Fax: 214-369-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberJ7572
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: