Individual
CHARLES MANNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3009 N BALLAS RD, SUITE 105B, SAINT LOUIS, MO 63131-2322
(314) 432-2323
(314) 432-5328
Mailing address
3009 N BALLAS RD, SUITE 105B, SAINT LOUIS, MO 63131-2322
(314) 432-2323
(314) 432-5328
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
32416
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0900023
UNITED HEALTHCARE
MO
01
—
122201
HEALTHLINK
MO
01
—
22185
BCBS OF MO (ANTHEM)
MO
01
—
3124702001
CIGNA
MO
01
—
3567
GROUP HEALTH PLAN
MO
01
—
4210117
AETNA
MO
01
—
43092556563080A001
WPS TRICARE
—
01
—
A12809
MERCY HEALTH PLANS
MO
01
—
P00195673
RR MEDICARE
MO
Enumeration date
01/19/2007
Last updated
11/09/2007
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