Dr Robert Borden Wilson, MD | |
2300 Hospital Dr Ste 120, Bossier City, LA 71111-2193 | |
(318) 212-7982 | |
(318) 212-7989 |
Full Name | Dr Robert Borden Wilson |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 2300 Hospital Dr Ste 120, Bossier City, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1477971885 | NPI | - | NPPES |
2449508 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 306374 (Louisiana) | Primary |
Entity Name | Wk Preferred Pediatrics |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1760043491 PECOS PAC ID: 9931537974 Enrollment ID: O20200325001138 |
Mailing Address | Practice Location Address |
---|---|
Dr Robert Borden Wilson, MD 1202 Louisiana Ave, Shreveport, LA 71101-3910 Ph: (318) 212-8951 | Dr Robert Borden Wilson, MD 2300 Hospital Dr Ste 120, Bossier City, LA 71111-2193 Ph: (318) 212-7982 |
Manohar R. Manchandia, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2706 Shed Rd, Bossier City, LA 71111 Phone: 318-747-5272 Fax: 318-746-9669 | |
Dr. Zack G Sanders, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2400 Hospital Dr, Ste 120, Bossier City, LA 71111 Phone: 318-742-6710 Fax: 318-747-5393 | |
Randall Glen White Jr., MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2300 Hospital Dr Ste 120, Bossier City, LA 71111 Phone: 318-212-7982 Fax: 318-212-7989 | |
Quynh Tran Dang, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2300 Hospital Dr Ste 340, Bossier City, LA 71111 Phone: 318-212-7883 Fax: 318-212-7885 | |
Dr. Jacqueline J Gray, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2300 Hospital Dr Ste 420, Bossier City, LA 71111 Phone: 318-212-7880 | |
Jennifer Kelley, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 5751 Shed Rd Ste 120, Bossier City, LA 71111 Phone: 318-935-1922 Fax: 318-935-1925 |