Provider Demographics
NPI:1538262522
Name:MOUS, DIRK HARMEN (MD)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:HARMEN
Last Name:MOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-383-3076
Mailing Address - Fax:209-383-6301
Practice Address - Street 1:374 W OLIVE AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-383-3076
Practice Address - Fax:209-383-6301
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G378950Medicaid
CAA47273Medicare UPIN
CA00G378950Medicaid