Provider Demographics
NPI:1023123734
Name:MCMANIGLE, MARK A (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MCMANIGLE
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 1:900 W SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643-1017
Mailing Address - Country:US
Mailing Address - Phone:520-384-4421
Mailing Address - Fax:520-384-4645
Practice Address - Street 1:900 W SCOTT ST
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1017
Practice Address - Country:US
Practice Address - Phone:520-384-4421
Practice Address - Fax:520-384-4645
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF26897Medicare UPIN