Individual
CHRISTOPHER M. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2449 HOSPITAL DR, SUITE 280, BOSSIER CITY, LA 71111-2399
(318) 841-4004
(318) 841-4008
Mailing address
2449 HOSPITAL DR, SUITE 280, BOSSIER CITY, LA 71111-2399
(318) 841-4004
(318) 841-4008
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
200947
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1092100
—
LA
01
—
4P065
MEDICARE PTAN
LA
Enumeration date
05/22/2007
Last updated
06/16/2021
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