Southern Endocrinology Center

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

12099R Issued in LA

Legal business name

SOUTHERN ENDOCRINOLOGY CENTER

Practice address

3418 Medical Park Dr
Suite 23
Monroe, LA 71203-2376

Phone

(318) 398-9580

NPI assigned

Sep 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohammad Mousa, M.D.NPI 1841383221

Title

Owner

Phone

(318) 398-9580

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohammad Mousa, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Monroe, LA
  • NPI 1841383221
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629161005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4766",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712114766",
            "telephone_number": "318-398-9580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3418 MEDICAL PARK DR",
            "address_2": "SUITE 23",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712032376",
            "telephone_number": "318-398-9580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ENDOCRINOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOUSA",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-398-9580",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "LA",
            "license": "12099R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1696595",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Endocrinology, Diabetes & Metabolism Physician in Monroe, LA
• Providers in Monroe, LA by specialty
• Endocrinology, Diabetes & Metabolism Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.