Individual
DR. GINA LYNNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0800
Mailing address
6457 PROVINCE LN, BATON ROUGE, LA 70808-3579
(225) 456-3105
(225) 767-4608
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD201912
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200199880
—
IN
Enumeration date
01/27/2006
Last updated
05/04/2018
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