Provider Demographics
NPI:1730107699
Name:MUCHMORE, JAMES HARRISON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HARRISON
Last Name:MUCHMORE
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 1:352 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-6903
Mailing Address - Country:US
Mailing Address - Phone:318-473-1426
Mailing Address - Fax:318-473-1435
Practice Address - Street 1:352 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6903
Practice Address - Country:US
Practice Address - Phone:318-473-1426
Practice Address - Fax:318-473-1435
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05586R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319228Medicaid
B65030Medicare UPIN
LA1319228Medicaid