Individual
PAUL STUART WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1666 E BERT KOUNS INDUSTRIAL LOOP STE 105, SHREVEPORT, LA 71105-5718
(318) 212-3520
(318) 212-3525
Mailing address
1666 E BERT KOUN LOOP STE 105, SHREVEPORT, LA 71105-5718
(318) 212-3520
(318) 212-3525
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
020189
LA
207RA0401X
Addiction Medicine (Internal Medicine) Physician
MD.020189
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1911879
—
LA
Enumeration date
07/07/2006
Last updated
12/01/2022
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