Provider Demographics
NPI:1447455134
Name:MANCINI, JOHN GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
Last Name:MANCINI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:6071 E WOODMEN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2613
Mailing Address - Country:US
Mailing Address - Phone:719-531-7007
Mailing Address - Fax:719-531-7122
Practice Address - Street 1:6071 E WOODMEN RD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2613
Practice Address - Country:US
Practice Address - Phone:719-531-7007
Practice Address - Fax:719-531-7122
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01627208800000X
CODR.0052818208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48770299Medicaid