Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD00043382 | WA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD00043382 | WA |
NPI | 1033150420 |
---|---|
Provider Name | David Michael Mourning |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Mount Vernon, WA 98273-5445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8918MO | REGENCE BLUESHIELD (01) | |
8939669 | CRIME VICTIMS COMP (01) | WA |
BM6639213 | DEA (01) | |
I03157 | (02) | |
P00161526 | RAILROAD MEDICARE (01) |