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General NPI Number Information
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NPI Number | 1578548475
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Entity Type | Individual
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Provider Name | JOEY M MANDUANO D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2219 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74114-1411
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Country | US
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Telephone | 918-749-5522
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Fax | 918-747-5522
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Provider Business Mailing Address
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Address Line | 2219 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74114-1411
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Country | US
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Telephone | 918-749-5522
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Fax | 918-747-5522
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 1628
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License Number State | OK
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