Individual
AMMOURA MOHAMMED IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.B.CH.B
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1541 KINGS HWY, ATTN: PAYOR CREDENTIALING, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
342369
LA
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
342369
LA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
342369
LA
Other
Enumeration date
03/27/2017
Last updated
11/01/2024
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