Individual
THOMAS CRELLIN MANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6140 W CURTISIAN AVE STE 400, BOISE, ID 83704-8907
(208) 327-5600
(208) 327-5602
Mailing address
6140 W CURTISIAN AVE STE 400, BOISE, ID 83704-8907
(208) 327-5600
(208) 327-5602
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M9928
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006154
OMAP
—
01
—
0222532
WA DEPT OF LABOR
ID
01
—
100001035500
REGENCE BLUESHIELD OF IDAHO
ID
05
—
1861501637
—
ID
01
—
20140
BLUE CROSS OF IDAHO
ID
01
—
8944944
CRIMES VICTIMS
—
Enumeration date
08/29/2006
Last updated
05/09/2022
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