Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 21133 | WV |
NPI | 1003900051 |
---|---|
Provider Name | Rida S Mazagri |
First Address | Huntington, WV 25701 |
Second Address | Huntington, WV 25701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 09/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2004750000 | (05) | WV |
2406471 | (05) | OH |
64068406 | (05) | KY |
H08818 | (02) |