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General NPI Number Information
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NPI Number | 1366937138
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Entity Type | Individual
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Provider Name | BLAINE T MANNING MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 2325 DOUGHERTY FERRY RD STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3356
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Country | US
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Telephone | 314-909-1359
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Fax | 314-909-1370
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Provider Business Mailing Address
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Address Line | 1120 15TH ST # OR6000
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-3813
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 95437
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2018020296
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License Number State | MO
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