Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34-00-8184 M | OH |
NPI | 1003826819 |
---|---|
Provider Name | Dr. Mostafa Mirhaidari |
First Address | Uniontown, OH 44685-7854 |
Second Address | Uniontown, OH 44685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 01/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2544830 | (05) | OH |
I 32642 | (02) | OH |