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Individual
DR. GERALD WADE MOUTON
Active
Individual
DR. GERALD WADE MOUTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
018271
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1357880
—
LA
01
—
52011DD92
MEDICARE
LA
Enumeration date
01/16/2007
Last updated
05/12/2022
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