Provider Demographics
NPI:1740414895
Name:MANNAS, JONATHAN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:MANNAS
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 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3601 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1229
Practice Address - Country:US
Practice Address - Phone:806-791-0399
Practice Address - Fax:806-791-0373
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8746207T00000X, 207T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519360YKT8OtherMEDICARE
TX8GC015OtherBCBS TX
TX221101200OtherFIRSTCARE
TX360501601Medicaid
NM84977060Medicaid
TX519360YKT8Medicare PIN