Individual
DR. JAMES J. MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12709 TOEPPERWEIN RD STE 306, LIVE OAK, TX 78233-3223
(210) 967-0096
(210) 967-0383
Mailing address
4411 MEDICAL DR, 300, SAN ANTONIO, TX 78229-3822
(210) 614-5400
(210) 614-2413
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
N2181
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284764203
—
TX
01
—
316704YR99
MEDICARE
TX
01
—
8DV607
BCBSTX
TX
01
—
P01251180
RR MEDICARE
TX
Enumeration date
12/27/2007
Last updated
07/21/2022
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