Provider Demographics
NPI:1821003567
Name:CONRAD C MANAYAN D.O. P.C.
Entity Type:Organization
Organization Name:CONRAD C MANAYAN D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-624-2822
Mailing Address - Street 1:1775 W SAINT MARYS RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2696
Mailing Address - Country:US
Mailing Address - Phone:520-624-2822
Mailing Address - Fax:520-624-4222
Practice Address - Street 1:1775 W SAINT MARYS RD
Practice Address - Street 2:SUITE 116
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2696
Practice Address - Country:US
Practice Address - Phone:520-624-2822
Practice Address - Fax:520-624-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC0145OtherRAILROAD MEDICARE
AZDC0145OtherRAILROAD MEDICARE