Demitra T Manjoros, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

36049 Issued in AZ

Practice address

7700 E Florentine Rd
BLDG B, Ste. 203
Prescott Valley, AZ 86314-2245

Phone

(928) 442-8740

Fax

(928) 442-8142

NPI assigned

Feb 10, 2006

Last updated

Feb 3, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1811960651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "928-759-5987",
            "fax_number": "928-458-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 E FLORENTINE RD",
            "address_2": "BLDG B, STE. 203",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142245",
            "telephone_number": "928-442-8740",
            "fax_number": "928-442-8142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANJOROS",
        "first_name": "DEMITRA",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "36049",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "DR.0052970",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ LICENSE",
            "identifier": "36049",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81522886",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael G Macon, M.D.
• Scott Madsen, P.T.
• Claudia Adriana Magda
• Patrick James Mahaney, MD
• Crystal Marie Makinson
• Heather Mann, LMT
• John D Marin, DPM
• Markle & More Inc
• Richard Charles Martin, RPH
• Sara Martin, LMT, MSACN

• Surgery Physician in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.