Individual
JAMES R MANGERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
515 NE GLEN OAK AVE STE 202, PEORIA, IL 61603-3166
(309) 624-4455
(309) 624-3457
Mailing address
515 NE GLEN OAK AVE STE 202, PEORIA, IL 61603-3166
(309) 624-4455
(309) 624-3457
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085010994
IL
363A00000X
Physician Assistant
2956
WI
363A00000X
Physician Assistant
50.008880RX
OH
Other
Enumeration date
06/20/2012
Last updated
01/27/2025
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