Provider Demographics
NPI:1215425871
Name:MANN, PHILLIP BOYD JR (DO)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BOYD
Last Name:MANN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:901 HEARTLAND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3460
Mailing Address - Country:US
Mailing Address - Phone:832-325-7280
Mailing Address - Fax:713-512-7104
Practice Address - Street 1:901 HEARTLAND RD STE 1800
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6202
Practice Address - Country:US
Practice Address - Phone:816-232-8877
Practice Address - Fax:816-232-0307
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023025695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist