MEDICARE: RONALD M. MANN, M.D. P.C.

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	207ND0101X	MOHS-Micrographic Surgery Physician	31923	AZ
2	207N00000X	Dermatology Physician	31923	AZ

General Provider Information

NPI Number	:	1861688434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD M. MANN, M.D. P.C.

Provider Business Mailing Address
First Line	:	5700 E PIMA ST
Second Line	:	SUITE I
City	:	TUCSON
State	:	AZ
Zip	:	85712-5601
Country	:	US
Telephone Number	:	520-529-8883
Fax Number	:	520-290-0039

Provider Business Practice Location Address
First Line	:	5700 E PIMA ST
Second Line	:	SUITE I
City	:	TUCSON
State	:	AZ
Zip	:	85712-5601
Country	:	US
Telephone Number	:	520-529-8883
Fax Number	:	520-290-0039

Authorized Official
Title or Position	:	MANAGER
Name	:	RONALD MAYNARD MANN
Credential	:
Telephone Number	:	520-529-8883

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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