# DR. GERALD PETER MCMANAMA III

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

## Provider details

- **NPI number:** 1780619601
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | MD160341 | OR | Yes |
| 2086S0129X | Vascular Surgery Physician | R7H29 | MO | — |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 04/14/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 202643524 | — | MO |
| 05 | — | 500654960 | — | OR |
| 01 | — | 770000741 | RAILROAD MEDICARE | MO |