Provider Demographics
NPI:1396717906
Name:HANLINE, MANNING H JR (MD)
Entity type:Individual
Prefix:
First Name:MANNING
Middle Name:H
Last Name:HANLINE
Suffix:JR
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 1:1717 NORTH E STREET
Mailing Address - Street 2:SUITE 526
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501
Mailing Address - Country:US
Mailing Address - Phone:850-438-1878
Mailing Address - Fax:850-433-1778
Practice Address - Street 1:1717 NORTH E STREET
Practice Address - Street 2:SUITE 526
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-438-1878
Practice Address - Fax:850-433-1778
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02029OtherBC FL
4306740OtherAETNA
AL590 00561OtherBC AL
D50298Medicare UPIN
FL02029OtherBC FL