MEDICARE: ERON GRANT MANUSOV 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
1	207QS0010X	Sports Medicine (Family Medicine) Physician	P8943	TX
2	207Q00000X	Family Medicine Physician	P8943	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	H08FR76401	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1477523447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERON GRANT MANUSOV MD

Provider Business Mailing Address
First Line	:	PO BOX 531968
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78553-1968
Country	:	US
Telephone Number	:	338-887-4863
Fax Number	:	956-296-6857

Provider Business Practice Location Address
First Line	:	2106 TREASURE HILLS BLVD # 1.326
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8736
Country	:	US
Telephone Number	:	956-296-1519
Fax Number	:	956-296-1331

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	04/29/2024

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