Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G5410 | TX |
N | 207PE0004X | Emergency Medical Services | G5410 | TX |
NPI | 1063479376 |
---|---|
Provider Name | Michael W Mouw |
First Address | Austin, TX 78739-1742 |
Second Address | Austin, TX 78701-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 19/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125535805 | (05) | TX |
B63137 | (02) | TX |