Individual
MIA FANGUY HAMIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2727 HEARNE AVE, SUITE 300, SHREVEPORT, LA 71103-3931
(318) 798-9400
(318) 798-3894
Mailing address
PO BOX 51008, SHREVEPORT, LA 71135-1008
(318) 798-9400
(318) 798-3894
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200072
LA
363A00000X
Physician Assistant
PA04871
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1822191
—
LA
Enumeration date
11/28/2007
Last updated
01/27/2012
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