Provider Demographics
NPI:1376707323
Name:MCMANUS, SHAWN PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PATRICK
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N 1100 E STE A
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2054
Mailing Address - Country:US
Mailing Address - Phone:801-855-3844
Mailing Address - Fax:801-855-3854
Practice Address - Street 1:680 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2241
Practice Address - Country:US
Practice Address - Phone:801-768-1699
Practice Address - Fax:801-768-4526
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7925558-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1376707323Medicaid
MNP00918761OtherRAILROAD MEDICARE
UTU000074299Medicare PIN