Healthcare Provider Details

I. General information

NPI: 1801729694
Provider Name (Legal Business Name): MANNING FACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL DR STE 210
BOUNTIFUL UT
84010-8903
US

IV. Provider business mailing address

520 MEDICAL DR STE 210
BOUNTIFUL UT
84010-8903
US

V. Phone/Fax

Practice location:
  • Phone: 208-670-3876
  • Fax:
Mailing address:
  • Phone: 208-670-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES PATRICK MANNING III
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 208-670-3876