Provider Demographics
NPI:1861512006
Name:MCMANUS, JIMMY W (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:W
Last Name:MCMANUS
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 1:17300 HENDERSON PASS STE 260
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1568
Mailing Address - Country:US
Mailing Address - Phone:210-908-7573
Mailing Address - Fax:
Practice Address - Street 1:17300 HENDERSON PASS STE 260
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1568
Practice Address - Country:US
Practice Address - Phone:210-908-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH35912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B74995Medicare UPIN
TXB74995Medicare UPIN