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Individual
MARY MANIS
Active
Individual
MARY MANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J1974
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011KW
BLUECROSS BLUESHIELD
TX
01
—
127101
SUPERIOR
TX
05
—
1286064-06
—
TX
01
—
1286064-07
MEDICAID THSTEPS
TX
01
—
P00166344
MEDICARE RAILROAD
—
Enumeration date
08/02/2005
Last updated
03/30/2026
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