Provider Demographics
NPI:1083701858
Name:MANNING, GERALD EDWARD II (PAC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:EDWARD
Last Name:MANNING
Suffix:II
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 876009
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687
Mailing Address - Country:US
Mailing Address - Phone:907-357-0820
Mailing Address - Fax:907-357-0821
Practice Address - Street 1:5050 DUNBAR
Practice Address - Street 2:SUITE D
Practice Address - City:WASILLA
Practice Address - State:AL
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-0820
Practice Address - Fax:907-357-0821
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0059363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKS31229Medicare UPIN