Provider Demographics
NPI:1992785844
Name:MANN, JAMES A (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:610 30TH AVE WEST
Mailing Address - Street 2:ALEXANDRIA CLINIC
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-763-5123
Mailing Address - Fax:320-763-7883
Practice Address - Street 1:610 30TH AVE WEST
Practice Address - Street 2:ALEXANDRIA CLINIC
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-763-5123
Practice Address - Fax:320-763-7883
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN650213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN480031286OtherRR MEDICARE
MN918193800Medicaid
MN918193800Medicaid
U84033Medicare UPIN