Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 16312 | TN |
N | 111NI0900X | Internist | 16312 | TN |
N | 207R00000X | Internist | 29639 | CO |
N | 111NI0900X | Internist | 29639 | CO |
N | 208000000X | Pediatrician | 16312 | TN |
N | 208000000X | Pediatrician | 29639 | CO |
N | 2080P0214X | Pediatric Pulmonologist | 16312 | TN |
N | 2080P0214X | Pediatric Pulmonologist | 29639 | CO |
NPI | 1326005810 |
---|---|
Provider Name | Ricky T Mohon |
First Address | Aurora, CO 80045-2545 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 17/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A97839 | (02) |