Individual
MARTIN JOSEPH MANGAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 DOVE RUN RD, SUITE 200, LEXINGTON, KY 40502-3536
(859) 269-4668
(859) 266-5577
Mailing address
1055 DOVE RUN RD, SUITE 200, LEXINGTON, KY 40502-3536
(859) 269-4668
(859) 266-5577
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32706
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64327067
—
KY
Enumeration date
05/27/2006
Last updated
11/03/2016
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