Mark Douglas Wilson
Sports Medicine Orthopaedic Surgeon
216 W Union St Ste. A
Minden
, Louisiana 71055-3216
Mark Douglas Wilson
Sports Medicine Orthopaedic Surgeon
216 W Union St Ste. A
Minden
, Louisiana 71055-3216
(574) 329-1445
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About
Features
Specialties
- Sports Medicine Orthopaedic Surgeon
Languages spoken
- English
Location
First Address
- Mark Douglas Wilson
- 186 Colonel A.p. Kouns Dr.
- Shreveport, LA
- Zip : 71115
- Phone : (574) 329-1445
Second Address
- Mark Douglas Wilson
- 216 W Union St Ste. A
- Minden, LA
- Zip : 71055-3216
- Phone : (318) 299-6334
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD.204547 | LA |
National Provider Identifier
| NPI | 1235399163 |
|---|---|
| Provider Name | Mark Douglas Wilson |
| First Address | Shreveport, LA 71115 |
| Second Address | Minden, LA 71055-3216 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/06/2008 |
| Last Update Date | 29/07/2015 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.