Individual
DR. ANTHONY MANNINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
126 E MAIN ST, STE B, PAYSON, AZ 85541
(928) 468-8610
(928) 468-8605
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 522-9879
(928) 522-9880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO02797
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133760
—
AZ
01
—
AZ0856210
BLUE CROSS BLUE SHIELD
—
Enumeration date
04/08/2006
Last updated
06/22/2020
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