Provider Demographics
NPI:1003882358
Name:MANES, JOSE L (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:MANES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12420 ROYAL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8150
Mailing Address - Country:US
Mailing Address - Phone:314-205-6983
Mailing Address - Fax:314-205-6830
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-205-6983
Practice Address - Fax:314-205-6830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO33297207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13653Medicare UPIN