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General NPI Number Information
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NPI Number | 1912001520
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Entity Type | Individual
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Provider Name | DAVID A MESIBOV MD
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Gender | Male
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 118 CENTRAL PARK SQUARE
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City | LOS ALAMOS
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State | NM
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Zip | 87544
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Country | US
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Telephone | 505-662-4798
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1250 118 CENTRAL PARK SQUARE
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City | LOS ALAMOS
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State | NM
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Zip | 87544
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Country | US
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Telephone | 505-662-4798
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Fax | 505-661-9637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 97-99
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License Number State | NM
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