Provider Demographics
NPI:1174742050
Name:RICHARD H MANN DPM PA
Entity type:Organization
Organization Name:RICHARD H MANN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-276-0900
Mailing Address - Street 1:11082 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7217
Mailing Address - Country:US
Mailing Address - Phone:561-276-0900
Mailing Address - Fax:561-276-0998
Practice Address - Street 1:11082 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7217
Practice Address - Country:US
Practice Address - Phone:561-276-0900
Practice Address - Fax:561-276-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1198213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0562301-00Medicaid
FL97327Medicare ID - Type Unspecified
FL0562301-00Medicaid
FL0771480001Medicare NSC