Individual
DR. JOEY M MANDUANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2219 E 21ST ST, TULSA, OK 74114-1411
(918) 749-5522
(918) 747-5522
Mailing address
2219 E 21ST ST, TULSA, OK 74114-1411
(918) 749-5522
(918) 747-5522
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
1628
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731047122001
BCBS OF OKLAHOMA
OK
Enumeration date
12/13/2005
Last updated
07/08/2007
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