MEDICARE: DR. WILLIAM TROY MANARD 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	207Q00000X	Family Medicine Physician	2002018253	MO
2	2083C0008X	Clinical Informatics Physician	2002018253	MO

General Provider Information

NPI Number	:	1912927534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM TROY MANARD MD

Provider Business Mailing Address
First Line	:	3660 VISTA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2540
Country	:	US
Telephone Number	:	314-977-4702
Fax Number	:	314-977-4703

Provider Business Practice Location Address
First Line	:	3660 VISTA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2540
Country	:	US
Telephone Number	:	314-977-4702
Fax Number	:	314-977-4703

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	01/31/2017

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