Basic Information
| Provider Information | |||||||||
| NPI: | 1023123734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMANIGLE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 W SCOTT ST | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203844421 | ||||||||
| FaxNumber: | 5203844645 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W SCOTT ST | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203844421 | ||||||||
| FaxNumber: | 5203844645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2586 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.