Individual
ROBERT MANIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 CRESTWOOD CIR, MENA, AR 71953-5512
(479) 394-3887
(479) 394-7758
Mailing address
PO BOX 295, LOCKESBURG, AR 71846-0295
(870) 289-5865
(870) 289-6993
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C4843
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102561001
—
AR
01
—
12711000000
QUALCHOICE
AR
01
—
53296
BCBS
AR
Enumeration date
10/10/2005
Last updated
02/08/2010
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