Provider Demographics
NPI:1346222999
Name:MANTHEIY, JOSEPH RICHARD III (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RICHARD
Last Name:MANTHEIY
Suffix:III
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 1:132 BROADMOOR ST
Mailing Address - Street 2:
Mailing Address - City:MEADOWLAKES
Mailing Address - State:TX
Mailing Address - Zip Code:78654-6602
Mailing Address - Country:US
Mailing Address - Phone:830-385-3641
Mailing Address - Fax:
Practice Address - Street 1:132 BROADMOOR ST
Practice Address - Street 2:
Practice Address - City:MEADOWLAKES
Practice Address - State:TX
Practice Address - Zip Code:78654-6602
Practice Address - Country:US
Practice Address - Phone:830-385-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8257207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125096103Medicaid
TX82990KOtherBCBS
TX82990KMedicare PIN
TX82990KOtherBCBS
TX125096103Medicaid