Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D6830 | TX |
N | 111NI0900X | Internist | D6830 | TX |
Y | 207U00000X | Nuclear Medicine Specialist | D6830 | TX |
NPI | 1104912385 |
---|---|
Provider Name | David Eugene Mouton |
First Address | Pearland, TX 77584-7298 |
Second Address | Houston, TX 77057-2209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124291905 | (05) | TX |
124291907 | (05) | TX |
124291910 | (05) | TX |