Individual
DR. WILLIAM ALFRED MIXON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1717 OAK PARK BLVD, SUITE 1, LAKE CHARLES, LA 70601-8991
(337) 478-3810
(337) 478-6360
Mailing address
1717 OAK PARK BLVD, SUITE 1, LAKE CHARLES, LA 70601-8991
(337) 478-3810
(337) 478-6360
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
09373
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1112437
—
LA
01
—
5846182
AETNA
LA
Enumeration date
11/16/2005
Last updated
07/08/2007
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