Provider Demographics
NPI:1588059018
Name:LARRY I MANN, MD
Entity type:Organization
Organization Name:LARRY I MANN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-298-2860
Mailing Address - Street 1:3024 N PLACITA FUENTE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3429
Mailing Address - Country:US
Mailing Address - Phone:520-298-2860
Mailing Address - Fax:520-298-2860
Practice Address - Street 1:3024 N PLACITA FUENTE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3429
Practice Address - Country:US
Practice Address - Phone:520-298-2860
Practice Address - Fax:520-298-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5228261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center