Individual
MR. JUSTIN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(870) 510-0171
Mailing address
61 WEESNER AVE UNIT 3, WILLIAMSBURG, KY 40769-2051
(870) 510-0171
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
346971
LA
Other
Enumeration date
07/30/2019
Last updated
05/23/2025
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