1447372396 NPI number — DR. CHIZOBA N MOSIERI MD

Table of content: DR. CHIZOBA N MOSIERI MD (NPI 1447372396)

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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