Individual
MARK DOUGLAS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
216 W UNION ST, STE. A, MINDEN, LA 71055-3216
(318) 299-6334
Mailing address
186 COLONEL A.P. KOUNS DR., SHREVEPORT, LA 71115
(574) 329-1445
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
MD.204547
LA
Other
Enumeration date
06/13/2008
Last updated
07/29/2015
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