Individual
DR. MATTHEW SAND MOSURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2005 LANDRY DRIVE, BOSSIER CITY, LA 71111
(318) 752-7850
(318) 752-7855
Mailing address
1534 ELIZABETH AVE STE 301, SHREVEPORT, LA 71101-4531
(318) 629-5001
(318) 629-5020
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
15597R
LA
208VP0014X
Interventional Pain Medicine Physician
15597R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01249632
RR
LA
Enumeration date
05/02/2007
Last updated
07/31/2020
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