Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ronnie Daniel Mantilla, MD

Individual provider Pulmonary Disease Physician · NPI 1164785549

Ronnie Daniel Mantilla, MD is a Pulmonary Disease in Lumberton, North Carolina. Qualified in 2007, 19 years ago. Practices with Southeastern Regional Medical Center, a 49-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho and North Carolina.

Years since qualifying
19
Licensed in
ID, NC
In the registry since
2012
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4760 Independence Dr
Lumberton, NC 28358-2328
Phone: (910) 738-9414
Fax: (910) 738-1012
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 700 W Ironwood Dr Ste 378, Coeur D Alene, ID 83814-4401 — (208) 625-3555

Specialties & licences

Pulmonary Disease Physician (primary) Taxonomy 207RP1001X · Licence 2024-00547 (NC)
Pulmonary Disease Physician Taxonomy 207RP1001X · Licence M15022 (ID)

Record details

NPI number1164785549
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 20, 2012
Last updated in NPPESDecember 18, 2024
Certification dateDecember 18, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPULMONARY DISEASE
Also practisesCRITICAL CARE (INTENSIVISTS)
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Southeastern Regional Medical Center — 49 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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