Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | C7691 | TX |
NPI | 1245227545 |
---|---|
Provider Name | Dr. Anthony S. Manfre |
First Address | Brenham, TX 77833-9227 |
Second Address | Brenham, TX 77833-9227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2005 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B24602 | (02) | TX |