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General NPI Number Information
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NPI Number | 1306840087
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Entity Type | Individual
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Provider Name | GREGORIO MANUEL MANABAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 1504 W REYNOLDS ST STE C
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City | PONTIAC
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State | IL
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Zip | 61764-9779
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Country | US
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Telephone | 815-842-2893
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Fax | 815-844-5960
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Provider Business Mailing Address
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Address Line | 1504 W REYNOLDS ST STE C
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City | PONTIAC
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State | IL
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Zip | 61764-9779
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Country | US
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Telephone | 815-842-2893
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Fax | 815-844-5960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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