Provider Demographics
NPI:1457391476
Name:MANN, THOMAS NELSON (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:NELSON
Last Name:MANN
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 1:2121 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2922
Mailing Address - Country:US
Mailing Address - Phone:253-301-6850
Mailing Address - Fax:
Practice Address - Street 1:2121 S 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2922
Practice Address - Country:US
Practice Address - Phone:253-301-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029226207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0155125OtherL & I PROVIDER NUMBER
WA4219636OtherAETNA PROVIDER NUMBER
WA98372K002OtherTRICARE PROVIDER NUMBER
WA1093731Medicaid
WA91120349460OtherKPS PROVIDER NUMBER
WAMA8568OtherREGENCE RIDER NUMBER
WA98372K002OtherTRICARE PROVIDER NUMBER