Individual
MARK MATTHEW WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1337 CENTRE CT, ALEXANDRIA, LA 71301
(318) 445-9331
(318) 619-6899
Mailing address
1337 CENTRE CT, ALEXANDRIA, LA 71301-3405
(318) 445-9331
(318) 619-6899
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
019488
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1934780
—
LA
Enumeration date
08/26/2005
Last updated
08/27/2018
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