Provider Demographics
NPI:1962485995
Name:MANN, DANA J (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:MANN
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 1:1460 NE MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6061
Mailing Address - Country:US
Mailing Address - Phone:541-382-6633
Mailing Address - Fax:541-382-2719
Practice Address - Street 1:1460 NE MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6061
Practice Address - Country:US
Practice Address - Phone:541-382-6633
Practice Address - Fax:541-382-2719
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR287772085R0202X
CO330072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300090323OtherRAILROAD MEDICARE
CO01330075Medicaid
COP00351363OtherRAILROAD MEDICARE
CO300135773OtherRAILROAD MEDICARE
CO01330075Medicaid
COC469538Medicare PIN
COP00351363OtherRAILROAD MEDICARE
CO300090323OtherRAILROAD MEDICARE