Individual
DR. MARK RICHARD MAINOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8001 YOUREE DR, SUITE 840, SHREVEPORT, LA 71115-2302
(318) 212-2846
Mailing address
8001 YOUREE DR, SUITE 840, SHREVEPORT, LA 71115-2302
(318) 212-2846
(318) 212-2845
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
07555R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1968579
—
LA
Enumeration date
07/03/2006
Last updated
07/08/2021
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