Provider Demographics
NPI:1275518367
Name:VALERIE B MANNING DO PLLC
Entity Type:Organization
Organization Name:VALERIE B MANNING DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-945-5240
Mailing Address - Street 1:3330 NW 56TH STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-945-5240
Mailing Address - Fax:405-945-5263
Practice Address - Street 1:3330 NW 56TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4479
Practice Address - Country:US
Practice Address - Phone:405-945-5240
Practice Address - Fax:405-945-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3811207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100019470AMedicaid
H30993Medicare UPIN
OK100019470AMedicaid