Individual
MR. KEITH MUSSOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RT (R)
Contact information
Practice address
13154 COIT RD, DALLAS, TX 75240-5773
(443) 235-4991
Mailing address
12573 GRANITE FALLS TRL, FRISCO, TX 75035-0086
(443) 235-4991
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
96693
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
457059
THE AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGIST
—
01
—
96693
CERTIFIED MEDICAL RADIOLOGIC TECHNOLOGIST
TX
Enumeration date
09/26/2013
Last updated
08/16/2016
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