Provider Demographics
NPI:1043295652
Name:MANNING, EVERALD O (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERALD
Middle Name:O
Last Name:MANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 ALMEDA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5655
Mailing Address - Country:US
Mailing Address - Phone:713-521-7865
Mailing Address - Fax:712-521-7856
Practice Address - Street 1:4825 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5655
Practice Address - Country:US
Practice Address - Phone:713-521-7865
Practice Address - Fax:712-521-7856
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128203001Medicaid
TX128203001Medicaid
TXP00138356Medicare PIN
TX8B2706Medicare PIN