Individual
DR. JAMES M. MWATIBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 W SAINT MARY BLVD STE 320, LAFAYETTE, LA 70506-4693
(337) 470-3120
(337) 470-2320
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(337) 470-3120
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14561R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1576212
—
LA
Enumeration date
10/07/2005
Last updated
06/30/2022
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