# SOUTHERN ENDOCRINOLOGY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629161005
- **Authorized official:** MOHAMMAD MOUSA M.D. (OWNER)
- **Authorized official phone:** (318) 398-9580

## Contact information

- **Practice address:** 3418 MEDICAL PARK DR, SUITE 23, MONROE, LA 71203-2376
- **Practice address phone:** (318) 398-9580
- **Mailing address:** PO BOX 4766, MONROE, LA 71211-4766
- **Mailing address phone:** (318) 398-9580

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | 12099R | LA | Yes |

## Other

- **Enumeration date:** 09/30/2006
- **Last updated:** 08/22/2020