Provider Demographics
NPI:1932296324
Name:MANN, RICHARD HOWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HOWARD
Last Name:MANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5259
Mailing Address - Country:US
Mailing Address - Phone:561-276-0900
Mailing Address - Fax:
Practice Address - Street 1:258 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5259
Practice Address - Country:US
Practice Address - Phone:561-276-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1198213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55487Medicare UPIN
FL87648Medicare ID - Type Unspecified