Paul S Wilson MD LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PAUL S WILSON MD LLC

Practice address

595 Unadilla St
Shreveport, LA 71106-1239

Phone

(318) 455-8841

NPI assigned

Dec 9, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul S Wilson, MDNPI 1902838105

Title

Member

Phone

(318) 455-8841

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Stuart Wilson, MD

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1902838105
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614211200000",
    "number": "1952907578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 UNADILLA ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711061239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 UNADILLA ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711061239",
            "telephone_number": "318-455-8841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL S WILSON MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "318-455-8841",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1911879",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Patty, DPT
• Ravish V Patwardhan, M.D.
• Ananta Paudel
• Paul G Crawford MD and Willis-Knighton Medical Center
• Paul S Wilson MD and Willis-Knighton Medical Center
• Edward Paul, MD
• Ricky Allen Paul, MD
• Jennifer Paulovich, RDN
• Adrian Payne
• Antonio Payne

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.