Provider Demographics
NPI:1992776835
Name:MOAK, HUEY H (MD)
Entity type:Individual
Prefix:
First Name:HUEY
Middle Name:H
Last Name:MOAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SERIO BLVD
Mailing Address - Street 2:PO BOX 1787
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334
Mailing Address - Country:US
Mailing Address - Phone:318-757-3696
Mailing Address - Fax:318-757-8099
Practice Address - Street 1:112 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334
Practice Address - Country:US
Practice Address - Phone:318-757-3696
Practice Address - Fax:318-757-8099
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1360198Medicaid
LA52427Medicare ID - Type Unspecified
LA1360198Medicaid