Individual
DR. GERALD WADE MOUTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2750 ASTER ST, LAKE CHARLES, LA 70601-8824
(337) 480-8900
(337) 480-8901
Mailing address
PO BOX 122539, DEPT 2539, DALLAS, TX 75312-2539
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
018271
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1357880
—
LA
01
—
52011DD92
MEDICARE
LA
Enumeration date
01/16/2007
Last updated
05/12/2022
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