Provider Demographics
NPI:1942286299
Name:MANN, RICHARD CLEMENT JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLEMENT
Last Name:MANN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 SE 17TH ST
Mailing Address - Street 2:BLDG 200
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4621
Mailing Address - Country:US
Mailing Address - Phone:352-351-0060
Mailing Address - Fax:352-351-4130
Practice Address - Street 1:1500 SE 17TH ST
Practice Address - Street 2:BLDG 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4621
Practice Address - Country:US
Practice Address - Phone:352-351-0060
Practice Address - Fax:352-351-4130
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME38610207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D62430Medicare UPIN
FL42182VMedicare ID - Type Unspecified