Healthcare Provider Details

I. General information

NPI: 1952388969
Provider Name (Legal Business Name): MERLIN ROBERT WILSON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 NAPOLEON AVE SUITE 530
NEW ORLEANS LA
70115-6357
US

IV. Provider business mailing address

2633 NAPOLEON AVE SUITE 530
NEW ORLEANS LA
70115-6357
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-1120
  • Fax: 504-899-2137
Mailing address:
  • Phone: 504-899-1120
  • Fax: 504-899-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number010956
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: