Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1042186 | DC |
N | 207QA0505X | Family Doctor - Adult Medicine | RN1042186 | DC |
NPI | 1194494914 |
---|---|
Provider Name | Jay Mason Mounteer |
First Address | Washington, DC 20011-4319 |
Second Address | Washington, DC 20011-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2021 |
Last Update Date | 07/09/2021 |