Individual
JIMMY R. MASCARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
3768
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0739672
—
IA
01
—
28586
BCBS
IA
01
—
28587
BCBS OTHER
IA
01
—
IA01J4
UHC
IA
Enumeration date
11/14/2006
Last updated
10/16/2007
Update your record
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