Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 0101251301 | VA |
N | 207XS0117X | Orthopaedic Spine Surgeon | 255689 | NY |
N | 207XS0117X | Orthopaedic Spine Surgeon | MD042613 | DC |
NPI | 1003098351 |
---|---|
Provider Name | Fred Mo |
First Address | Washington, DC 20007-2113 |
Second Address | Washington, DC 20007-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 02/07/2015 |