# DR. JERED MARC MANCELL

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

## Provider details

- **NPI number:** 1942437140
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | 5101018298 | MI | — |
| 207YS0123X | Facial Plastic Surgery Physician | 9230 | SD | Yes |

## Other

- **Enumeration date:** 06/15/2009
- **Last updated:** 07/16/2014