Provider Demographics
NPI:1588688402
Name:MANSFIELD, JOHN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:MANSFIELD
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 1:2200 E SHOW LOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7831
Mailing Address - Country:US
Mailing Address - Phone:928-537-5600
Mailing Address - Fax:928-532-8665
Practice Address - Street 1:4951 S WHITE MOUNTAIN RD BLDG A
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7827
Practice Address - Country:US
Practice Address - Phone:360-425-3720
Practice Address - Fax:360-425-0090
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMDMD60129085208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ086721Medicaid
F56865Medicare UPIN