Individual
MARLA LOFTON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
510 E STONER AVE DEPT OF, SHREVEPORT, LA 71101-4243
(318) 990-4975
Mailing address
510 E STONER AVE DEPT OF, SHREVEPORT, LA 71101-4243
(318) 990-4975
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA 037
MS
363AS0400X
Surgical Physician Assistant
Primary
A10436
LA
Other
Enumeration date
04/24/2007
Last updated
09/14/2023
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