Basic Information
Provider Information
NPI: 1528295656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOGASSBI
FirstName: AYOUB
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 222 S WOODS MILL RD STE 760
Address2:  
City: CHESTERFIELD
State: MO
PostalCode: 630173625
CountryCode: US
TelephoneNumber: 3142056050
FaxNumber: 3144345939
Practice Location
Address1: 540 E JEFFERSON ST STE 202
Address2:  
City: IOWA CITY
State: IA
PostalCode: 522452460
CountryCode: US
TelephoneNumber: 3193582773
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/16/2009
LastUpdateDate: 10/10/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X2009007974MON Allopathic & Osteopathic PhysiciansInternal Medicine 
207RE0101XMD-45227IAY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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