Individual
RONALD EDWARD MANICOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 W 38TH ST, D-4, AUSTIN, TX 78705-1121
(512) 454-9627
(512) 454-6310
Mailing address
711 W 38TH ST, D-4, AUSTIN, TX 78705-1121
(512) 454-9627
(512) 454-6310
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C9055
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180051801
—
TX
Enumeration date
09/08/2005
Last updated
01/20/2010
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