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NPI Code Detail

MEDICARE: JOHN ALEXANDER MANOS MD

MEDICARE: JOHN ALEXANDER MANOS MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine PhysicianP3925TX
3208M00000XHospitalist Physician8566566-1205UT

General Provider Information

NPI Number : 1285864413
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN ALEXANDER MANOS MD
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-507-4384
Fax Number :
Provider Business Practice Location Address
First Line : 8 TH AVE & C ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84143-5220
Country : US
Telephone Number : 801-507-4384
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2009
Last Update Date : 07/21/2022

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