Provider Demographics
NPI:1477757730
Name:MANTILLA, EMMANUEL CEMPRON JR (DO)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:CEMPRON
Last Name:MANTILLA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:200 WEST MAGNOLIA AVE, SUITE 201
Mailing Address - Street 2:ACCLAIM PHYSICIAN GROUP
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-702-2385
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST STE 502
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4909
Practice Address - Country:US
Practice Address - Phone:817-702-8400
Practice Address - Fax:817-927-3982
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHOT6189225X00000X
TXR57712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist