Provider Demographics
NPI:1639127848
Name:MANWARING, JOHN W (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MANWARING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 400 N
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1347
Mailing Address - Country:US
Mailing Address - Phone:801-489-8464
Mailing Address - Fax:801-798-8513
Practice Address - Street 1:5 E 400 N
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663
Practice Address - Country:US
Practice Address - Phone:801-489-8464
Practice Address - Fax:801-798-8513
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1000731206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS87070Medicare UPIN
UT005502599Medicare ID - Type UnspecifiedMEDICARE