Individual
DR. MARK WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1415 TULANE AVE, NEW ORLEANS, LA 70112-2600
(504) 988-2300
(504) 988-3969
Mailing address
1430 TULANE AVE, TW22, NEW ORLEANS, LA 70112-2632
(504) 988-2300
(504) 988-3969
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
13693R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1425184
—
LA
Enumeration date
12/20/2006
Last updated
07/09/2007
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