Provider Demographics
NPI:1417062456
Name:MANN, FRED S (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:S
Last Name:MANN
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 1:1313 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1252
Mailing Address - Country:US
Mailing Address - Phone:305-858-2228
Mailing Address - Fax:305-541-3220
Practice Address - Street 1:1313 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1252
Practice Address - Country:US
Practice Address - Phone:305-858-2228
Practice Address - Fax:305-541-3220
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0051964207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061433500Medicaid
FL061433500Medicaid
FL07503Medicare ID - Type Unspecified