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NPI Code Detail

MEDICARE: JEFFREY L MANSOOR MD INC

MEDICARE: JEFFREY L MANSOOR MD INC
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
1208VP0000XPain Medicine Physician
2208VP0014XInterventional Pain Medicine Physician

General Provider Information

NPI Number : 1851322028
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEFFREY L MANSOOR MD INC
Provider Business Mailing Address
First Line : PO BOX 7096
Second Line :
City : STOCKTON
State : CA
Zip : 95267-0096
Country : US
Telephone Number : 209-956-7725
Fax Number : 209-956-7733
Provider Business Practice Location Address
First Line : 525 W ACACIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95203-2405
Country : US
Telephone Number : 209-944-5550
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JEFFREY L MANSOOR
Credential : MD
Telephone Number : 209-944-5550
Provider Enumeration Date : 07/06/2006
Last Update Date : 03/08/2021

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