Provider Demographics
NPI:1861688434
Name:RONALD M. MANN, M.D. P.C.
Entity Type:Organization
Organization Name:RONALD M. MANN, M.D. P.C.
Other - Org Name:CATALINA DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MAYNARD
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-529-8883
Mailing Address - Street 1:5700 E PIMA ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5601
Mailing Address - Country:US
Mailing Address - Phone:520-529-8883
Mailing Address - Fax:520-290-0039
Practice Address - Street 1:5700 E PIMA ST
Practice Address - Street 2:SUITE I
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5601
Practice Address - Country:US
Practice Address - Phone:520-529-8883
Practice Address - Fax:520-290-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31923207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH47244Medicare UPIN