Provider Demographics
NPI:1023143518
Name:WILSON B. BABER MD LLC
Entity type:Organization
Organization Name:WILSON B. BABER MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:BLOOMFIELD
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-221-3403
Mailing Address - Street 1:PO BOX 44309
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71134-4309
Mailing Address - Country:US
Mailing Address - Phone:318-221-3403
Mailing Address - Fax:318-221-6744
Practice Address - Street 1:1455 E BERT KOUN LOOP STE 207
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5634
Practice Address - Country:US
Practice Address - Phone:318-221-3403
Practice Address - Fax:318-221-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021943207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1179851Medicaid
TX195783901Medicaid
LA5CE23Medicare PIN
LA5E504CE23Medicare PIN
TX8F8475Medicare PIN
TX00Z403Medicare PIN