| Paul S Wilson Md Llc | |
|
595 Unadilla St Shreveport LA 71106-1239 | |
| (318) 455-8841 | |
| Not Available |
| Full Name | Paul S Wilson Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 595 Unadilla St, Shreveport, Louisiana |
| Authorized Official Name and Position | Paul S Wilson (MEMBER) |
| Authorized Official Contact | 3184558841 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul S Wilson Md Llc 595 Unadilla St Shreveport LA 71106-1239 Ph: () - | Paul S Wilson Md Llc 595 Unadilla St Shreveport LA 71106-1239 Ph: (318) 455-8841 |
| NPI Number | 1952907578 |
|---|---|
| Provider Enumeration Date | 12/09/2020 |
| Last Update Date | 02/25/2021 |
| Medicare PECOS PAC ID | 5294148011 |
|---|---|
| Medicare Enrollment ID | O20210114002981 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952907578 | NPI | - | NPPES |
| 1911879 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Paul Stuart Wilson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902838105 PECOS PAC ID: 8426153669 Enrollment ID: I20070418000027 |
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