Organization
IMPERIAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA MOSSALLATI DO (MEMBER MANAGER)
(318) 425-4096
Entity
Organization
Contact information
Practice address
1800 IRVING PL, SHREVEPORT, LA 71101-4608
(318) 425-4096
(318) 425-8438
Mailing address
PO BOX 64568, PHOENIX, AZ 85082-4568
(318) 424-5449
(855) 230-1466
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
303623
LA
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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