Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0101043068 | VA |
NPI | 1053344200 |
---|---|
Provider Name | Dr. Assaad M. Mounzer |
First Address | Bluefield, WV 24701-3304 |
Second Address | Bluefield, WV 24701-3304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 07/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010322588 | (05) | VA |
0129976000 | (05) | WV |
218683 | ANTHEM BLUE CROSS (01) | VA |
B42728 | (02) |