Individual
JOSEPH MULLASSERIL JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O,
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103
(318) 212-4000
Mailing address
PO BOX 3488, TUPELO, MS 38803-3488
(832) 605-3477
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
310128
LA
2085R0202X
Diagnostic Radiology Physician
R0258
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370924801
—
TX
01
—
370924802
CSHCN
TX
Enumeration date
04/27/2012
Last updated
07/26/2019
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