Provider Demographics
NPI:1841453883
Name:W. J. MANUEL, MD, PA
Entity type:Organization
Organization Name:W. J. MANUEL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-762-5445
Mailing Address - Street 1:4211 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5320
Mailing Address - Country:US
Mailing Address - Phone:228-762-5445
Mailing Address - Fax:228-762-8050
Practice Address - Street 1:4211 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5320
Practice Address - Country:US
Practice Address - Phone:228-762-5445
Practice Address - Fax:228-762-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherCORPORATION TAX ID
MSD73580Medicare UPIN
MS072616897Medicare PIN