Individual
DR. MIKELSON MOMPREMIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,F.A.C.S.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
P7164
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
P7164
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P0198400
DPS
TX
01
—
P7164
MEDICAL LICENSE
TX
Enumeration date
04/08/2009
Last updated
03/07/2023
Update your record
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