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General NPI Number Information
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NPI Number | 1811287782
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Entity Type | Individual
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Provider Name | DANIEL BROOKS MANNAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 2700 FARMINGTON AVE BLDG E STE 1
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City | FARMINGTON
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State | NM
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Zip | 87401-4559
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Country | US
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Telephone | 505-609-6380
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Fax | 505-599-4641
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Provider Business Mailing Address
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Address Line | PO BOX 6210
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City | FARMINGTON
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State | NM
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Zip | 87499-6210
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Country | US
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Telephone | 505-609-2258
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Fax | 505-609-2259
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD2016-0480
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License Number State | NM
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