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General NPI Number Information
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NPI Number | 1538363015
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Entity Type | Individual
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Provider Name | JOHN C MANSOUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 5323 HARRY HINES BLVD COMPREHENSIVE CANCER CENTER
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City | DALLAS
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State | TX
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Zip | 75390-7201
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Country | US
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Telephone | 214-648-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 6912 MEADOWBRIAR LN
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City | DALLAS
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State | TX
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Zip | 75230-4251
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Country | US
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Telephone | 347-306-4654
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 60 236390
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License Number State | NY
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