# MARK C MOUTON MD LLC

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

## Provider details

- **NPI number:** 1760626170
- **Authorized official:** DR. MARK CHRISTIAN MOUTON MD (MEMBER)
- **Authorized official phone:** (504) 621-3298

## Contact information

- **Practice address:** 12880 PLANK RD, BAKER, LA 70714-4909
- **Practice address phone:** (225) 774-7111
- **Practice address fax:** (225) 774-7714
- **Mailing address:** 12880 PLANK RD, BAKER, LA 70714-4909
- **Mailing address phone:** (225) 774-7111
- **Mailing address fax:** (225) 774-7714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MD.201233 | LA | Yes |

## Other

- **Enumeration date:** 04/29/2009
- **Last updated:** 07/01/2014