Individual
DR. THEODORE ANDREW MANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8424 E SHEA BLVD, STE. 101, SCOTTSDALE, AZ 85260-6662
(480) 256-1520
(480) 478-6628
Mailing address
30099 N 129TH DR, PEORIA, AZ 85383-5267
(928) 501-6666
(928) 501-6566
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
37050
AZ
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
37050
AZ
208VP0014X
Interventional Pain Medicine Physician
37050
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015031
—
WA
05
—
1123777
—
WA
05
—
325833
—
AZ
Enumeration date
07/05/2006
Last updated
09/05/2019
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