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General NPI Number Information
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NPI Number | 1013202563
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Entity Type | Individual
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Provider Name | CYNTHIA R MOUTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 5 MOBILE INFIRMARY CIR
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City | MOBILE
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State | AL
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Zip | 36607-3513
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Country | US
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Telephone | 251-435-7289
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 SPRING HILL AVE
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City | MOBILE
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State | AL
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Zip | 36604-1402
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Country | US
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Telephone | 251-435-7289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23568
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD.33021
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License Number State | AL
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