Individual
JOHN R MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 CARTHAGE ST, SANFORD, NC 27330-4104
(919) 774-6518
(919) 774-1831
Mailing address
205 PAGE RD, PINEHURST, NC 28374-8798
(910) 295-5511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26630
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0138728
UNITED HEALTH CARE
NC
01
—
27463
MEDCOST
NC
01
—
53847
BCBS
NC
05
—
8953847
—
NC
01
—
FH1100100
FIRSTCAROLINACARE
NC
01
—
P00869137
PALMETTO GBA - R/R MEDICARE
—
Enumeration date
08/09/2005
Last updated
01/23/2017
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