Individual
DR. DEMITRA T MANJOROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7700 E FLORENTINE RD, BLDG B, STE. 203, PRESCOTT VALLEY, AZ 86314-2245
(928) 442-8740
(928) 442-8142
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(928) 759-5987
(928) 458-2039
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
36049
AZ
208600000X
Surgery Physician
DR.0052970
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36049
AZ LICENSE
AZ
05
—
81522886
—
AZ
Enumeration date
02/10/2006
Last updated
02/03/2016
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