Provider Demographics
NPI:1184620882
Name:MANNING, GEORGE S (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:MANNING
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 1:1300 CLIPSTON DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9436
Mailing Address - Country:US
Mailing Address - Phone:806-773-6324
Mailing Address - Fax:
Practice Address - Street 1:1300 CLIPSTON DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9436
Practice Address - Country:US
Practice Address - Phone:806-773-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB162056OtherMEDICARE
TX858520OtherBLUECROSS BLUESHIELD
TX114945202Medicaid
TX114945205Medicaid
TX114945202Medicaid
TXC47161Medicare UPIN
TX858520OtherBLUECROSS BLUESHIELD