Organization Name: | RONALD E. MANICOM, MD, PA |
NPI Number: | 1891820106 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANGELA FOUSS (OFFICE MANAGER) |
Mailing Address: | 1200 Lakeway Dr Suite 8 Lakeway |
State: | TX US |
Postal Code: | 787344474 |
Phone Number: | 5122489000 |
Fax Number: | 5122489012 |
NPI Enumeration Date: | 02/23/2007 |
NPI Last Update Date: | 11/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | C9055 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |