Basic Information
| Provider Information | |||||||||
| NPI: | 1679654313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANUBAY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | #101 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527990046 | ||||||||
| FaxNumber: | 3527990115 | ||||||||
| Practice Location | |||||||||
| Address1: | 11343 CORTEZ BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346135404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525965919 | ||||||||
| FaxNumber: | 3525965918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 01/14/2015 | ||||||||
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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 | 2086S0129X | ME 75741 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3668439 | 01 | FL | AETNA | OTHER | P00015977 | 01 | FL | RAILROAD MEDICARE | OTHER | 341975257 | 01 | FL | TRICARE | OTHER | 341975257 0004 | 01 | FL | CIGNA | OTHER | 241641 | 01 | FL | AVMED | OTHER | P01387681 | 01 | FL | RAILROAD MEDICARE | OTHER | 449310 | 01 | FL | BC BS NATL ACCOUNT | OTHER | 00889 | 01 | FL | UNIVERSAL | OTHER | 217051 | 01 | FL | WELLCARE | OTHER | 44931 | 01 | FL | BC BS OF FL | OTHER |