Provider Demographics
NPI:1720369267
Name:MANN, RALPH JERRY (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:JERRY
Last Name:MANN
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 1:325 TURKEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-7471
Mailing Address - Country:US
Mailing Address - Phone:870-591-6833
Mailing Address - Fax:
Practice Address - Street 1:325 TURKEY CREEK RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-7471
Practice Address - Country:US
Practice Address - Phone:870-591-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE