Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 7027 | AZ |
N | 208D00000X | General Practice Physician | 007027 | AZ |
N | 208D00000X | General Practice Physician | OS13524 | FL |
NPI | 1083024921 |
---|---|
Provider Name | Dr. Mitchell Ryan Manway |
First Address | Scottsdale, AZ 85255-4107 |
Second Address | Scottsdale, AZ 85255-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 12/10/2020 |