Individual
DR. ROGER CHARLES MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1619 N GREENWOOD ST, SUITE 208, PUEBLO, CO 81003-2644
(719) 561-4336
(719) 561-8469
Mailing address
1619 N GREENWOOD ST, SUITE 208, PUEBLO, CO 81003-2644
(719) 561-4336
(719) 561-8469
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
31281
CO
207Q00000X
Family Medicine Physician
Primary
31281
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01312818
—
CO
Enumeration date
01/11/2006
Last updated
07/31/2019
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