Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | J0136 | TX |
NPI | 1194721696 |
---|---|
Provider Name | Dale E Mohar |
First Address | Charlotte, NC 28260-3725 |
Second Address | Kerrville, TX 78028-6071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 26/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1A1591 | MEDICARE PTAN (01) | TX |
F34702 | (02) | TX |