Healthcare Provider Details

I. General information

NPI: 1255725032
Provider Name (Legal Business Name): JAMES PATRICK MANNING III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 E 12200 S STE 200
DRAPER UT
84020-9888
US

IV. Provider business mailing address

2255 N ROBINS DR STE 205
LAYTON UT
84041-1181
US

V. Phone/Fax

Practice location:
  • Phone: 801-776-2220
  • Fax:
Mailing address:
  • Phone: 801-776-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number12941670-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: