Provider Demographics
NPI:1649486143
Name:JON F. MANJARRIS, M.D.,P.A.
Entity type:Organization
Organization Name:JON F. MANJARRIS, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANJARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-241-0324
Mailing Address - Street 1:14317 NORTHWEST BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5536
Mailing Address - Country:US
Mailing Address - Phone:361-241-0324
Mailing Address - Fax:361-387-4153
Practice Address - Street 1:14317 NORTHWEST BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5536
Practice Address - Country:US
Practice Address - Phone:361-241-0324
Practice Address - Fax:361-387-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1772332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0362230002Medicare ID - Type UnspecifiedPALMETTO SUPPLIER