Organization
MOSAIC NEUROSCIENCE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID DURHAM M.D. (MANAGING DIRECTOR)
(602) 430-4746
Entity
Organization
Contact information
Practice address
1700 N UNION AVE, SUITE B, ROSWELL, NM 88201-3267
(602) 430-4746
Mailing address
1700 N UNION AVE, SUITE B, ROSWELL, NM 88201-3267
(602) 430-4746
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD2006-0490
NM
2084P0800X
Psychiatry Physician
Primary
2008-0595
NM
Other
Enumeration date
03/07/2012
Last updated
03/07/2012
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