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General NPI Number Information
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NPI Number | 1942251376
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Entity Type | Individual
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Provider Name | JOHN W MANNSCHRECK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 1254 HIGHLAND AVE
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City | CLARKSTON
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State | WA
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Zip | 99403-2841
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Country | US
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Telephone | 509-758-6132
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Fax | 509-751-9726
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Provider Business Mailing Address
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Address Line | 1254 HIGHLAND AVE
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City | CLARKSTON
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State | WA
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Zip | 99403-2841
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Country | US
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Telephone | 509-758-6132
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Fax | 509-751-9726
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M-6236
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD00026768
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License Number State | WA
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