Individual
TIMOTHY MANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13065 OLD TESSON FERRY RD, SAINT LOUIS, MO 63128-3441
(314) 647-9797
(314) 270-8520
Mailing address
PO BOX 14222, BELFAST, ME 04915-4035
(314) 647-9797
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2016016256
MO
208D00000X
General Practice Physician
35-065764
OH
Other
Enumeration date
01/05/2006
Last updated
07/08/2016
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