Doctor Name: | JAMES BRIAN MOELLER |
NPI Number: | 1497070080 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MT |
License Number: | 189324 |
Business Practice Address: | 100 Lake Traverse Drive Sisseton, SD - 57262 |
Business Phone Number: | 6057423792 |
Business Fax Number: | |
Mailing Address: | 100 Lake Traverse Drive, SISSETON |
State: | SD |
Postal Code: | 57262 |
Phone Number: | 6057423792 |
Fax Number: | |
NPI Enumeration Date: | 04/07/2010 |
NPI Last Update Date: | 04/07/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246QM0706X |
License Number: | 189324 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Spec/Tech, Pathology |
Taxonomy Specialization: | Medical Technologist |
Taxonomy Definition: |