Provider Demographics
NPI:1609848639
Name:MOUSSET, XAVIER RENE (MD)
Entity type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:RENE
Last Name:MOUSSET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:600 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5727
Practice Address - Country:US
Practice Address - Phone:337-439-5800
Practice Address - Fax:337-439-0003
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.15365R2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1175609Medicaid
E77140Medicare UPIN
LA1175609Medicaid
LAP00084669Medicare PIN
LA1175609Medicaid