MEDICARE: DEBORAH JOY MANNING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD112734	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25584030	OTHER	MO	BCBS PROVIDER NUMBER
2	MD112734	OTHER	MO	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1144262999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH JOY MANNING M.D.

Provider Business Mailing Address
First Line	:	4240 BLUE RIDGE BLVD.
Second Line	:	SUITE 611
City	:	KANSAS CITY
State	:	MO
Zip	:	64133
Country	:	US
Telephone Number	:	816-356-2020
Fax Number	:	816-356-2022

Provider Business Practice Location Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	SUITE 611
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1713
Country	:	US
Telephone Number	:	816-356-2020
Fax Number	:	816-356-2022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	10/09/2024

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