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General NPI Number Information
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NPI Number | 1922112085
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Entity Type | Organization
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Legal Business Name | ROGER A. MANN M.D., INC.
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 80 GRAND AVE 5TH FLOOR
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City | OAKLAND
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State | CA
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Zip | 94612-3725
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Country | US
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Telephone | 510-451-6266
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Fax | 510-451-6260
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Provider Business Mailing Address
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Address Line | 80 GRAND AVE 5TH FLOOR
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City | OAKLAND
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State | CA
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Zip | 94612-3725
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Country | US
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Telephone | 510-451-6266
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Fax | 510-451-6260
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER A. MANN
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Credential | M.D.
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Telephone | 510-451-6266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A20311
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License Number State | CA
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