Organization
WILLOW CHUTE MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLINT N. WILSON M.D. (OWNER)
(318) 349-3921
Entity
Organization
Contact information
Practice address
4910 AIRLINE DR, BOSSIER CITY, LA 71111-6607
(318) 349-3921
Mailing address
732 SMOKEHOUSE LOOP, BENTON, LA 71006-8000
(318) 349-3921
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/18/2023
Last updated
12/20/2023
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