Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO3191 | FL |
NPI | 1184623555 |
---|---|
Provider Name | Dr. Mousa R Bateh |
First Address | Jacksonville, FL 32204-1177 |
Second Address | Jacksonville, FL 32216-4246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 03/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340528100 | (05) | FL |
V05430 | (02) | FL |