Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | MD32127 | AL |
N | 2086S0129X | Vascular Surgeon | MD32487 | SC |
Y | 2086S0129X | Vascular Surgeon | ME112123 | FL |
NPI | 1023217908 |
---|---|
Provider Name | Dr. Ginger Lynne Manos |
First Address | Crestview, FL 32536-3442 |
Second Address | Crestview, FL 32536-3442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 09/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012102000 | (05) | FL |
161998 | (05) | AL |