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Individual

DR. STUART B MANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
6655 E US HIGHWAY 36, AVON, IN 46123-8923
(888) 714-1927
(317) 272-0807
Mailing address
5101 E US HIGHWAY 36 STE 100, AVON, IN 46123-6646
(888) 714-1927
(317) 272-0807

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01032748
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000083191
ANTHEM BCBS PROVIDER PIN
IN
05
200009770
IN
Enumeration date
05/18/2006
Last updated
07/31/2019
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