Provider Demographics
NPI:1366447559
Name:MANN, PAUL MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18850 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4288
Mailing Address - Country:US
Mailing Address - Phone:713-275-2457
Mailing Address - Fax:713-275-2466
Practice Address - Street 1:18850 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4288
Practice Address - Country:US
Practice Address - Phone:281-446-7900
Practice Address - Fax:281-446-4879
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7443152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB118670OtherMEDICARE INDIVIDUAL PTAN
TX116944305Medicaid
TX116944305Medicaid
TXTXB118670OtherMEDICARE INDIVIDUAL PTAN