Organization
PELICAN STATE FOOT & ANKLE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON M WILSON JR. DPM (OWNER)
(985) 867-0301
Entity
Organization
Contact information
Practice address
1938 JACKSON ST, ALEXANDRIA, LA 71301-6437
(985) 867-0301
Mailing address
PO BOX 1228, ALEXANDRIA, LA 71309-1228
(985) 867-0301
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DPM.200036
LA
Other
Enumeration date
04/07/2015
Last updated
07/23/2015
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