Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 2017029105 | MO |
N | 207W00000X | Ophthalmologist | L2316364 | MI |
NPI | 1013257575 |
---|---|
Provider Name | Mohannad Al-Samarraie |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-7214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2013 |
Last Update Date | 21/02/2018 |