Individual
DR. LAWRENCE GEORGE MANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
206 2ND ST E, BRADENTON, FL 34208-1042
(941) 955-4101
(941) 358-9817
Mailing address
8374 MARKET ST, BOX 502, LAKEWOOD RANCH, FL 34202-5137
(941) 955-4101
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
47695
MA
2085R0202X
Diagnostic Radiology Physician
Primary
ME83157
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000164100
—
FL
01
—
ME83157
LICENSE NO
FL
01
—
P00464359
RR MEDICARE
FL
Enumeration date
10/14/2005
Last updated
11/02/2016
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