1447372396 NPI number — DR. CHIZOBA N MOSIERI MD

Table of content: MR. JORGE CARLOS DOMINGUEZ RUIZ (NPI 1194224287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447372396 NPI number — DR. CHIZOBA N MOSIERI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSIERI
Provider First Name:
CHIZOBA
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447372396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 MAGNOLIA XING
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSSIER CITY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71111-5455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-495-0934
Provider Business Mailing Address Fax Number:
318-828-4038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 KINGS HWY
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ANESTHESIOLOGY, LSUHSC
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-495-0934
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  D0068052 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X , with the licence number: D0068052 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 208123401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1807664 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30536 . This is a "STATE OF SOUTH CAROLINA, LABOR, LICENSING, REGULATION. BOARD OF MEDICAL EXAMINER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: D0068052 . This is a "MARYLAND BOARD OF PHYSICIANS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 060540 . This is a "STATE OF GEORGIA, COMPOSITE STATE BOARD OF MEDICAL EXAMINERS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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