Provider Demographics
NPI:1780665711
Name:MANNING, MARK G (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:MANNING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78292-0437
Mailing Address - Country:US
Mailing Address - Phone:210-558-6288
Mailing Address - Fax:210-558-6289
Practice Address - Street 1:1801 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8001
Practice Address - Country:US
Practice Address - Phone:830-774-2505
Practice Address - Fax:830-774-2394
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2013-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3848208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF02048Medicare UPIN