Individual
ANTONIO S MANALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 CHURCH ST, SPRINGFIELD, CO 81073
(719) 523-6221
(719) 523-4290
Mailing address
373 E 10TH AVE, SPRINGFIELD, CO 81073
(719) 523-6221
(719) 523-4290
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21312
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01213123
—
CO
Enumeration date
12/01/2006
Last updated
01/17/2011
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