Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 9827 | MT |
NPI | 1649292681 |
---|---|
Provider Name | Bruce Arthur Mazat |
First Address | Aberdeen, MS 39730-9496 |
Second Address | Aberdeen, MS 39730-9496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 17/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B92604 | (02) |