NPIMap

Organization Active NPI

Mosaic Neuroscience Group

  • Psychiatry Physician
  • Roswell, NM
National Provider Identifier
1831463918
Registry record updated Mar 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2008-0595 Issued in NM
Legal business name
MOSAIC NEUROSCIENCE GROUP
Practice address
1700 N Union Ave
Suite B
Roswell, NM 88201-3267
Phone
(602) 430-4746
NPI assigned
Mar 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Durham, M.D.
Title
Managing Director
Phone
(602) 430-4746

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X MD2006-0490 NM
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 2008-0595 NM Primary

Addresses

Primary practice location

1700 N Union Ave
Suite B
Roswell, NM 88201-3267

Mailing address

1700 N Union Ave
Suite B
Roswell, NM 88201-3267
Phone (602) 430-4746

National Provider Directory

National Provider Directory

Locations

1700 N Union Ave
Ste B
Roswell, NM 88201
Phone (602) 430-4746

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331078400000",
    "number": "1831463918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 N UNION AVE",
            "address_2": "SUITE B",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882013267",
            "telephone_number": "602-430-4746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N UNION AVE",
            "address_2": "SUITE B",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882013267",
            "telephone_number": "602-430-4746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC NEUROSCIENCE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2012-03-07",
        "status": "A",
        "authorized_official_last_name": "DURHAM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "602-430-4746",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2006-0490",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "2008-0595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.