Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 224676 | NY |
Y | 2084N0400X | Neurologist | 7631 | SD |
NPI | 1013906759 |
---|---|
Provider Name | Rene L. Mosada |
First Address | Aberdeen, SD 57402-1460 |
Second Address | Aberdeen, SD 57401-4552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2005 |
Last Update Date | 03/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02267081 | (05) | NY |
H67468 | (02) | NY |