Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | M10842 | ID |
N | 207X00000X | Orthopaedic Surgeon | MD60836624 | WA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD60836624 | WA |
NPI | 1356451249 |
---|---|
Provider Name | Mr. Richard Emanuel Manos |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Mount Vernon, WA 98273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 18/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G761420 | (05) | CA |
2107953 | (05) | WA |
H94590 | (02) | CA |