Individual
DR. ROBERT BORDEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2300 HOSPITAL DR STE 120, BOSSIER CITY, LA 71111-2193
(318) 212-7982
(318) 212-7989
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8951
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
306374
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2449508
—
LA
Enumeration date
04/02/2014
Last updated
07/16/2019
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