Individual
WASSIM E MOUANNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
404 S 13TH AVE, LAUREL, MS 39440-4345
(601) 425-5544
(601) 425-5525
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 425-5544
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
18406
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09300503
—
MS
05
—
1782289
—
LA
01
—
640507572YS
AMERICAN ADMIN GROUP
MS
01
—
P00249340
RAILROAD MEDICARE
—
Enumeration date
08/20/2006
Last updated
08/23/2016
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