# JOHN R MANGUM

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1619978939
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 26630 | NC | Yes |

## Other

- **Enumeration date:** 08/09/2005
- **Last updated:** 01/23/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0138728 | UNITED HEALTH CARE | NC |
| 01 | — | 27463 | MEDCOST | NC |
| 01 | — | 53847 | BCBS | NC |
| 05 | — | 8953847 | — | NC |
| 01 | — | FH1100100 | FIRSTCAROLINACARE | NC |
| 01 | — | P00869137 | PALMETTO GBA - R/R MEDICARE | — |