=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740362938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD F MANN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 FLORA STREET
-----------------------------------------------------
City | PIKEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-432-4183
-----------------------------------------------------
Fax | 606-432-4270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2667 9 FLORA STREET
-----------------------------------------------------
City | PIKEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-432-4183
-----------------------------------------------------
Fax | 606-432-4270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 19915
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------