Healthcare Provider Details

I. General information

NPI: 1760443782
Provider Name (Legal Business Name): CHARLES E MANNER M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W HOLCOMBE BLVD 10TH FLOOR
HOUSTON TX
77030-3304
US

IV. Provider business mailing address

1140 BUSINESS CENTER DR STE 202
HOUSTON TX
77043-2741
US

V. Phone/Fax

Practice location:
  • Phone: 713-600-0900
  • Fax: 713-600-0070
Mailing address:
  • Phone: 713-800-0660
  • Fax: 713-827-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberF1773
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: