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General NPI Number Information
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NPI Number | 1467681486
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Entity Type | Individual
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Provider Name | ROBBIE THOMAS MANGALASSERIL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2009
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 1150 STATE HIGHWAY 248 STE 200
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City | BRANSON
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State | MO
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Zip | 65616-4186
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Country | US
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Telephone | 417-336-4112
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Fax | 417-335-4684
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Provider Business Mailing Address
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Address Line | PO BOX 4046
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City | SPRINGFIELD
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State | MO
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Zip | 65808-4046
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Country | US
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Telephone | 417-269-7241
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Fax | 417-269-7567
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2015030667
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License Number State | MO
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