Provider Demographics
NPI:1104997147
Name:MANGUNDAYAO, FELIZARDO HOCBO (MD)
Entity type:Individual
Prefix:DR
First Name:FELIZARDO
Middle Name:HOCBO
Last Name:MANGUNDAYAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239
Mailing Address - Country:US
Mailing Address - Phone:336-859-2121
Mailing Address - Fax:336-859-2122
Practice Address - Street 1:292 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239
Practice Address - Country:US
Practice Address - Phone:336-859-2121
Practice Address - Fax:336-859-2122
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890191AMedicaid
NC890191AMedicaid
NCD62850Medicare UPIN