# PELICAN STATE FOOT & ANKLE CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497141311
- **Authorized official:** DR. JON M WILSON JR. DPM (OWNER)
- **Authorized official phone:** (985) 867-0301

## Contact information

- **Practice address:** 1938 JACKSON ST, ALEXANDRIA, LA 71301-6437
- **Practice address phone:** (985) 867-0301
- **Mailing address:** PO BOX 1228, ALEXANDRIA, LA 71309-1228
- **Mailing address phone:** (985) 867-0301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | DPM.200036 | LA | Yes |

## Other

- **Enumeration date:** 04/07/2015
- **Last updated:** 07/23/2015