Provider Demographics
NPI:1689692139
Name:MANCHESTER, TROY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:L
Last Name:MANCHESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:CLEMENTS
Mailing Address - State:CA
Mailing Address - Zip Code:95227-0730
Mailing Address - Country:US
Mailing Address - Phone:650-421-5445
Mailing Address - Fax:650-587-0007
Practice Address - Street 1:420 W ACACIA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2441
Practice Address - Country:US
Practice Address - Phone:209-461-3196
Practice Address - Fax:209-461-7529
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA64766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84422Medicare UPIN