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NPI Code Detail

MEDICARE: PAUL STUART WILSON MD

MEDICARE: PAUL STUART WILSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RA0401XAddiction Medicine (Internal Medicine) PhysicianMD.020189LA
2207R00000XInternal Medicine Physician020189LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902838105
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL STUART WILSON MD
Provider Business Mailing Address
First Line : 1666 E BERT KOUN LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number : 318-212-3525
Provider Business Practice Location Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number : 318-212-3525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 12/01/2022

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