Provider Demographics
NPI:1366490229
Name:MANNEL, GEORGE S (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:MANNEL
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 1:1255 ASHBY ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5100
Mailing Address - Country:US
Mailing Address - Phone:830-372-0600
Mailing Address - Fax:830-372-0602
Practice Address - Street 1:1255 ASHBY ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5100
Practice Address - Country:US
Practice Address - Phone:830-372-0600
Practice Address - Fax:830-372-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6901207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033322102Medicaid
TXB24617Medicare UPIN