Provider Demographics
NPI:1689616989
Name:MANZANARES, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MANZANARES
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 1:7824 LAKE UNDERHILL RD
Mailing Address - Street 2:STE H
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8201
Mailing Address - Country:US
Mailing Address - Phone:877-977-7463
Mailing Address - Fax:407-792-4152
Practice Address - Street 1:7824 LAKE UNDERHILL ROAD SUITE H
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:877-977-7463
Practice Address - Fax:407-792-4152
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82473207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51311YOtherMEDICARE P-TAN
FL51311OtherBCBSFL
FLG46332Medicare UPIN
MDKR59L864Medicare ID - Type Unspecified