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General NPI Number Information
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NPI Number | 1912149535
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Entity Type | Individual
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Provider Name | MANAS JAIN MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 2520 CHERRY AVE
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City | BREMERTON
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State | WA
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Zip | 98310-4229
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Country | US
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Telephone | 360-377-3911
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 CHERRY AVE SUITE 302
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City | BREMERTON
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State | WA
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Zip | 98310-4202
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Country | US
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Telephone | 360-479-5083
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Fax | 360-479-5775
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 41368
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License Number State | AZ
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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 | MD60244399
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License Number State | WA
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