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General NPI Number Information
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NPI Number | 1457667487
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Entity Type | Individual
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Provider Name | BRUCE LEONARD WILSON M.D., M.S.P.H
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Gender | Male
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 10200 CHEF MENTEUR HWY STE A
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City | NEW ORLEANS
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State | LA
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Zip | 70127-4264
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Country | US
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Telephone | 504-603-6190
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Fax |
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Provider Business Mailing Address
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Address Line | 10200 CHEF MENTEUR HWY STE A
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City | NEW ORLEANS
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State | LA
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Zip | 70127-4264
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Country | US
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Telephone | 504-603-6190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA09945200
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License Number State | NJ
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