Individual
COREY MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 KINGS HIGHWAY, SHREVEPORT, LA 71103
(318) 626-0434
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/19/2025
Last updated
07/19/2025
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