Provider Demographics
NPI:1932101870
Name:MANCAO, MIGUEL Y (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:Y
Last Name:MANCAO
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 1:4901 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5935
Mailing Address - Country:US
Mailing Address - Phone:850-477-7042
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:4901 GRANDE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5935
Practice Address - Country:US
Practice Address - Phone:850-477-7042
Practice Address - Fax:850-474-9060
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56634207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009105620Medicaid
FL061908600Medicaid
FL09706OtherBLUECROSS & BLUESHIELD
FL050015910OtherRAILROAD MEDICARE
AL59094698OtherBLUECROSS & BLUESHIELD
FLZ191OtherHEALTH FIRST NETWORK
FL09706YMedicare PIN
FL050015910OtherRAILROAD MEDICARE