Manning, Irvin Randolph
Manning, Irvin Randolph is an individual health care provider with primary practice located at 1000 Mar Walt Dr , Fort Walton Beach FL 32547-6708. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Manning, Irvin Randolph can be contacted via phone (850) 862-1111.Contact Information
Primary practice address
1000 Mar Walt Dr
Fort Walton Beach FL 32547-6708
Phone: (850) 862-1111
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 15926 | Mississippi |
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | ME114277 | Florida |
Profile Details
| NPI number | 1609969732 |
|---|---|
| LBN Legal business name | Manning, Irvin Randolph |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 2nd, 2006 |
| Last updated | Jul 15th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609969732 | NPPES |
| Mississippi | MEDICAID | 00119622 |
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