Provider Demographics
NPI:1619056447
Name:MANNING, JAMES E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:MANNING
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:NAVAJO HWY 64
Mailing Address - Street 2:TSAILE HEALTH CENTER
Mailing Address - City:TSAILE
Mailing Address - State:AZ
Mailing Address - Zip Code:86556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVAJO HWY 64
Practice Address - Street 2:TSAILE HEALTH CENTER
Practice Address - City:TSAILE
Practice Address - State:AZ
Practice Address - Zip Code:86556
Practice Address - Country:US
Practice Address - Phone:928-724-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ870172Medicaid
AZ870172Medicaid
AZ8HC574Medicare ID - Type UnspecifiedMEDICARE PART B - TSAILE
WAA55052Medicare UPIN
AZ8HC573Medicare ID - Type UnspecifiedMEDICARE PART B - PINON