Individual
JEFFREY LAWRENCE MANSOOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
525 W ACACIA ST, STOCKTON, CA 95203-2405
(209) 956-7725
Mailing address
PO BOX 7096, STOCKTON, CA 95267-0096
(209) 956-7725
(209) 956-7733
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
G39910
CA
208VP0000X
Pain Medicine Physician
G39910
CA
208VP0014X
Interventional Pain Medicine Physician
Primary
G39910
CA
Other
Enumeration date
07/12/2006
Last updated
03/08/2021
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