Man Alive, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD00043839 Issued in WA

Legal business name

MAN ALIVE, LLC

Practice address

9430 NE Vancouver Mall Dr
Vancouver, WA 98662-6172

Phone

(360) 253-6947

NPI assigned

Jun 17, 2015

Organization subpart

No

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

Authorized official

Name

Dean Barrus

Title

Owner

Phone

(360) 984-5806

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1437530185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9430 NE VANCOUVER MALL DR",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626172",
            "telephone_number": "360-984-5806",
            "fax_number": "360-984-5994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 NE VANCOUVER MALL DR",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626172",
            "telephone_number": "360-253-6947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAN ALIVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-17",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "BARRUS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-984-5806"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00043839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Nicole Maltos
• Malik Andre Malutama
• Catherine Mamah, M.D.
• Murna Naomi Mamman
• Christopher Nicholas Mamula
• Sarah Man
• Laura Manae-Porter
• Mellany P. Manaig, MD
• Angela A Manalili, D.M.D.
• Mernyll Manalo, LPC

• Internal Medicine Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.