Individual
TIMOTHY C MANGRUM
Active
Individual
TIMOTHY C MANGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27482
TN
208000000X
Pediatrics Physician
027482
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01047325
AMERIGROUP-MCD
TN
01
—
12459471
MULTIPLAN/PHCS
TN
01
—
1735352
UNITED HEALTH CARE
TN
01
—
2790831
COVENTRY/FIRST HEALTH
TN
05
—
3801962
—
TN
01
—
4085154
BLUE CROSS OF TN
TN
01
—
5389663
AETNA
TN
01
—
549809
USA - MCO
TN
05
—
71000102000
—
KY
01
—
P00103889
MEDICARE RR
TN
Enumeration date
06/05/2006
Last updated
05/07/2015
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