Provider Demographics
NPI:1679654313
Name:MANUBAY, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:MANUBAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:#101
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-799-0115
Practice Address - Street 1:11343 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5404
Practice Address - Country:US
Practice Address - Phone:352-596-5919
Practice Address - Fax:352-596-5918
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 757412086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3668439OtherAETNA
FLP00015977OtherRAILROAD MEDICARE
FL341975257OtherTRICARE
FL341975257 0004OtherCIGNA
FL241641OtherAVMED
FLP01387681OtherRAILROAD MEDICARE
FL449310OtherBC BS NATL ACCOUNT
FL00889OtherUNIVERSAL
FL217051OtherWELLCARE
FL44931OtherBC BS OF FL
FLP00015977OtherRAILROAD MEDICARE