Provider Demographics
NPI:1902845738
Name:MANN, RONALD MAYNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MAYNARD
Last Name:MANN
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 1:7354 E VALLEY LIGHTS PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6267
Mailing Address - Country:US
Mailing Address - Phone:520-529-0556
Mailing Address - Fax:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31923207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH47244Medicare UPIN
AZZ80606Medicare ID - Type Unspecified