Provider Demographics
NPI:1871669077
Name:MANFREDONIA, JOHN F (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:MANFREDONIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 W. INA ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743
Mailing Address - Country:US
Mailing Address - Phone:520-730-6516
Mailing Address - Fax:520-514-2828
Practice Address - Street 1:7605 W. INA ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743
Practice Address - Country:US
Practice Address - Phone:520-730-6516
Practice Address - Fax:520-514-2828
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE-20692Medicare UPIN