Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 125059860 | IL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 01078326A | IN |
NPI | 1043506694 |
---|---|
Provider Name | Dr. John Paul Magno Manalo |
First Address | Fort Wayne, IN 46804-4133 |
Second Address | Fort Wayne, IN 46804-4133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 10/02/2020 |