Provider Demographics
NPI:1780619601
Name:MCMANAMA, GERALD PETER III (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PETER
Last Name:MCMANAMA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GERALD
Other - Middle Name:PETER
Other - Last Name:MCMANAMA
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3154 WEST 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-8381
Mailing Address - Country:US
Mailing Address - Phone:541-988-6200
Mailing Address - Fax:541-988-6215
Practice Address - Street 1:3154 WEST 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-988-6200
Practice Address - Fax:541-988-6215
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7H292086S0129X
ORMD1603412086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO770000741OtherRAILROAD MEDICARE
MO202643524Medicaid
OR500654960Medicaid
MOB96435Medicare UPIN
MO202643524Medicaid
OR500654960Medicaid