Individual
STEPHEN ROBERT MANOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 MOCKINGBIRD AVE, PARROTTSVILLE, TN 37843
(423) 625-1170
(423) 625-3618
Mailing address
PO BOX 99, PARROTTSVILLE, TN 37843-0099
(423) 625-1170
(423) 625-3618
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
42357
TN
207Q00000X
Family Medicine Physician
Primary
R4870
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3000070
—
TN
05
—
30000701
—
TN
05
—
30000702
—
TN
05
—
30000703
—
TN
05
—
30000704
—
TN
01
—
4156905
BCBST
TN
01
—
4156907
BCBST
TN
01
—
4156909
BCBST
TN
01
—
4156911
BCBST
TN
01
—
4156913
BCBST
TN
Enumeration date
05/24/2007
Last updated
11/22/2017
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