Individual
GREGORY GLENN MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 S COULTER ST, AMARILLO, TX 79106
(806) 414-9800
(806) 354-5689
Mailing address
1400 WALLACE BLVD, AMARILLO, TX 79106-1708
(806) 414-9800
(806) 354-5689
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2146
OK
363A00000X
Physician Assistant
PA-470
AR
363A00000X
Physician Assistant
Primary
PA08326
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200765750A
—
OK
05
—
27603512
—
NM
05
—
356196102
—
TX
05
—
356196103
—
TX
Enumeration date
03/01/2012
Last updated
08/01/2018
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