Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 16440 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 16440 | TX |
NPI | 1891805198 |
---|---|
Provider Name | Victor M Manon |
First Address | Kingwood, TX 77339 |
Second Address | Kingwood, TX 77339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 03/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16440 | LICENSE NUMBER (01) | TX |
U36075 | (02) | TX |