Individual
NICHOLAS RYAN MANGNITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4370 W MAIN ST, DOTHAN, AL 36305-1056
(334) 279-1450
Mailing address
625 19TH STREET SOUTH, BIRMINGHAM, AL 35249
(205) 934-4696
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD.36291
AL
207L00000X
Anesthesiology Physician
ME144262
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/29/2016
Last updated
06/04/2020
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