Individual
DR. JOHN A MANTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 UNIVERSITY BLVD E, SUITE 400, TUSCALOOSA, AL 35401
(205) 752-0694
(205) 752-6244
Mailing address
701 UNIVERSITY BLVD E, SUITE 400, TUSCALOOSA, AL 35401
(205) 752-0694
(205) 752-6244
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
6043
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000011168
—
AL
01
—
051011168
BLUE CROSS
AL
Enumeration date
04/12/2006
Last updated
10/09/2007
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