| Dr Demitra T Manjoros, MD | |
|
7700 E Florentine Rd, Bldg B, Ste. 203, Prescott Valley, AZ 86314-2245 | |
| (928) 442-8740 | |
| (928) 442-8142 |
| Full Name | Dr Demitra T Manjoros |
|---|---|
| Gender | Female |
| Speciality | Surgery |
| Location | 7700 E Florentine Rd, Prescott Valley, Arizona |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811960651 | NPI | - | NPPES |
| 81522886 | Medicaid | AZ | |
| 36049 | Other | AZ | AZ LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 36049 (Arizona) | Primary |
| 208600000X | Surgery | DR.0052970 (Colorado) | Secondary |
| Entity Name | Yavapai Regional Medical Center Physician Care Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1255582003 PECOS PAC ID: 5294898987 Enrollment ID: O20090106000798 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Demitra T Manjoros, MD Po Box 10880, Prescott, AZ 86304-0880 Ph: (928) 759-5987 | Dr Demitra T Manjoros, MD 7700 E Florentine Rd, Bldg B, Ste. 203, Prescott Valley, AZ 86314-2245 Ph: (928) 442-8740 |
Donald John Huang, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 3262 N Windsong Dr Bldg 2, Prescott Valley, AZ 86314 Phone: 928-771-4788 Fax: 928-771-5712 | |
Dr. Michael G Macon, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 7700 E Florentine Rd, Bldg B, Ste 203, Prescott Valley, AZ 86314 Phone: 928-442-8740 Fax: 928-442-8142 | |
Dr. Todd E Simon, D.O. Surgery Medicare: Accepting Medicare Assignments Practice Location: 3262 N Windsong Dr Bldg 2, Prescott Valley, AZ 86314 Phone: 928-759-5890 Fax: 928-458-2091 | |
Dr. John H. Payne, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 3262 N Windsong Dr Bldg 2, Prescott Valley, AZ 86314 Phone: 928-771-4788 Fax: 928-771-5712 |