Individual
THOMAS NELSON MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 S 19TH ST, TACOMA, WA 98405-2922
(253) 301-6850
Mailing address
2121 S 19TH ST, TACOMA, WA 98405-2922
(253) 301-6850
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD00029226
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD00029226
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0155125
L & I PROVIDER NUMBER
WA
05
—
1093731
—
WA
01
—
4219636
AETNA PROVIDER NUMBER
WA
01
—
91120349460
KPS PROVIDER NUMBER
WA
01
—
98372K002
TRICARE PROVIDER NUMBER
WA
01
—
MA8568
REGENCE RIDER NUMBER
WA
Enumeration date
06/07/2006
Last updated
08/06/2012
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