Individual
TABITHA MUUTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(514) 412-1100
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(514) 412-1100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
94-10332
KS
Other
Enumeration date
06/02/2020
Last updated
07/26/2021
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