Provider Demographics
NPI:1083024921
Name:MANWAY, MITCHELL RYAN (DO)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:RYAN
Last Name:MANWAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20401 N 73RD ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4107
Mailing Address - Country:US
Mailing Address - Phone:480-556-0446
Mailing Address - Fax:480-556-0447
Practice Address - Street 1:20401 N 73RD ST STE 230
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4153
Practice Address - Country:US
Practice Address - Phone:480-556-0446
Practice Address - Fax:480-556-0447
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ007027208D00000X
AZ7027207ND0101X, 207N00000X
FLOS13524208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207N00000XAllopathic & Osteopathic PhysiciansDermatology