Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | J7572 | TX |
Y | 213ES0000X | Sports Medicine | J7572 | TX |
NPI | 1326048059 |
---|---|
Provider Name | Melvin R Manning |
First Address | Dallas, TX 75205-5648 |
Second Address | Dallas, TX 75205-5648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76006 | (02) |