Dimitrios Mantzoros

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1068 Issued in TX

Legal business name

DIMITRIOS MANTZOROS

Practice address

100 Medical Center Blvd
Ste 216
Conroe, TX 77304-2888

Phone

(936) 756-9191

NPI assigned

Sep 30, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dimitrios Mantzoros, D.P.M.

Title

Physician

Phone

(936) 756-9191

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Dimitrios Spiros Mantzoros, DPM

  • Foot & Ankle Surgery Podiatrist
  • Conroe, TX
  • NPI 1285660803

  O20100930071222

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy Casperson, DPM

  • Foot & Ankle Surgery Podiatrist
  • Conroe, TX
  • NPI 1881857951
  NPD (past)
• Gurpreet K Mukker, DPM

  • Podiatrist
  • Conroe, TX
  • NPI 1518185719
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460592000000",
    "number": "1154571883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL CENTER BLVD",
            "address_2": "STE 216",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042888",
            "telephone_number": "936-756-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL CENTER BLVD",
            "address_2": "STE 216",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042888",
            "telephone_number": "936-756-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMITRIOS MANTZOROS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2016-04-14",
        "status": "A",
        "authorized_official_last_name": "MANTZOROS",
        "authorized_official_first_name": "DIMITRIOS",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "936-756-9191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "1068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180128401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yanira Diaz
• Larry R Diediker, L.A.T.
• Digestive and Liver Diseases Clinic PA
• Abigail Dillingham
• Melissa Rena Dimerson, APRN
• Ugochi Mary Diokpa
• Dmemd
• Andrea Doan
• Mary Gail Doddridge, RN
• Savannah Breann Dodds, OD

• Durable Medical Equipment & Medical Supplies in Conroe, TX
• Providers in Conroe, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.