Provider Demographics
NPI:1689109233
Name:MANSFIELD, JOHN TAYLOR (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TAYLOR
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BRADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2026
Mailing Address - Country:US
Mailing Address - Phone:607-222-0930
Mailing Address - Fax:
Practice Address - Street 1:86 BRADDOCK WAY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2026
Practice Address - Country:US
Practice Address - Phone:607-222-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01559208VP0014X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program