Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 200200747 | NC |
NPI | 1215912175 |
---|---|
Provider Name | Steven Shi-Tsen Mou |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 10/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1313P | BCBS (01) | NC |
2005065000 | (05) | WV |
6736998 | (05) | VA |
7930436 | AETNA (01) | NC |
800062 | PARTNERS (01) | NC |
891313P | (05) | NC |
B8058 | MEDCOST (01) | NC |
Q0074G | (05) | SC |