Healthcare Provider Details

I. General information

NPI: 1992776835
Provider Name (Legal Business Name): HUEY H MOAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SERIO BLVD
FERRIDAY LA
71334
US

IV. Provider business mailing address

112 SERIO BLVD PO BOX 1787
FERRIDAY LA
71334
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-3696
  • Fax: 318-757-8099
Mailing address:
  • Phone: 318-757-3696
  • Fax: 318-757-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number018269
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: