Basic Information
| Provider Information | |||||||||
| NPI: | 1912149535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | MANAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 CHERRY AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604795083 | ||||||||
| FaxNumber: | 3604795775 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 CHERRY AVE | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603773911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 11/10/2011 | ||||||||
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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 | 208800000X | 41368 | AZ | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD60244399 | WA | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.