Organization
MARK C MOUTON MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK CHRISTIAN MOUTON MD (MEMBER)
(504) 621-3298
Entity
Organization
Contact information
Practice address
12880 PLANK RD, BAKER, LA 70714-4909
(225) 774-7111
(225) 774-7714
Mailing address
12880 PLANK RD, BAKER, LA 70714-4909
(225) 774-7111
(225) 774-7714
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.201233
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1090484
—
LA
Enumeration date
04/29/2009
Last updated
07/01/2014
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