Basic Information
| Provider Information | |||||||||
| NPI: | 1306380928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MERRILL | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | ATTN: INTERNAL MEDICINE RESIDENCY | ||||||||
| City: | JBSA FT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109163910 | ||||||||
| FaxNumber: | 2109162077 | ||||||||
| Practice Location | |||||||||
| Address1: | 4076 NEELY ROAD | ||||||||
| Address2: | ATTN: DEPT OF BEHAVIORAL HEALTH | ||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4355121444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2016 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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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 | 103T00000X | 659 | WY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.