Individual
DR. MIKELSON MOMPREMIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,F.A.C.S.
Contact information
Practice address
1510 N HAMPTON RD, SUITE 290, DESOTO, TX 75115-8300
(469) 687-5664
Mailing address
1510 N HAMPTON RD STE 290, DESOTO, TX 75115-8300
(469) 687-5664
(469) 317-3344
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
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