# ROBERT DYLAN MANGRUM

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

## Provider details

- **NPI number:** 1871546838
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA9101478 | FL | — |
| 363AS0400X | Surgical Physician Assistant | PA172009 | OR | Yes |

## Other

- **Enumeration date:** 05/18/2006
- **Last updated:** 11/16/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1497748743 | GROUP NPI NUMBER / LRHSI | FL |
| 05 | — | 292286000 | — | FL |
| 05 | — | 500692609 | — | OR |
| 01 | — | DA5786 | RAILROAD MEDICARE GROUP NUMBER | FL |