Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E-6606 | AR |
N | 208D00000X | General Practice Physician | E6606 | AR |
NPI | 1023283710 |
---|---|
Provider Name | Dr. Mimo Rose Lemdja |
First Address | Camden, AR 71711-0757 |
Second Address | Camden, AR 71701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
183874001 | (05) | AR |