Basic Information
| Provider Information | |||||||||
| NPI: | 1477964146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12040 NE 128TH ST | ||||||||
| Address2: | MS-50 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980343013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258991920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 W ARBOR DR | ||||||||
| Address2: | MC 8894 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921039000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195437247 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2014 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD61083660 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | A143228 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.