Provider Demographics
NPI:1609852961
Name:MANSFIELD, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:MANSFIELD
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 1:7100 COMMERCE WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2829
Mailing Address - Country:US
Mailing Address - Phone:615-465-7000
Mailing Address - Fax:
Practice Address - Street 1:808 N UNION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3921
Practice Address - Country:US
Practice Address - Phone:575-623-5299
Practice Address - Fax:575-627-6415
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82-249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11965Medicaid
NMNM011777OtherBLUE CROSS/BLUE SHIELD
NMC97951Medicare UPIN
NMNM011777OtherBLUE CROSS/BLUE SHIELD