Individual
JONATHON SOSSAMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
403 W 8TH ST, DERIDDER, LA 70634-5507
(337) 463-8977
(337) 462-3093
Mailing address
PO BOX 935, DERIDDER, LA 70634-0935
(337) 463-8977
(337) 462-3093
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
303959
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2398318
—
LA
Enumeration date
04/27/2015
Last updated
07/03/2024
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