MEDICARE: MOHAMMAD MOUSA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	12099R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841383221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD MOUSA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4766
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71211-4766
Country	:	US
Telephone Number	:	318-398-9580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 MEDICAL PARK DR
Second Line	:	SUITE 23
City	:	MONROE
State	:	LA
Zip	:	71203-2376
Country	:	US
Telephone Number	:	318-398-9580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	07/16/2007

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