Provider Demographics
NPI:1952388969
Name:WILSON, MERLIN ROBERT JR (MD)
Entity type:Individual
Prefix:
First Name:MERLIN
Middle Name:ROBERT
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2633 NAPOLEON AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6357
Mailing Address - Country:US
Mailing Address - Phone:504-899-1120
Mailing Address - Fax:504-899-2137
Practice Address - Street 1:2633 NAPOLEON AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6357
Practice Address - Country:US
Practice Address - Phone:504-899-1120
Practice Address - Fax:504-899-2137
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010956207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1118923Medicaid
LA1118923Medicaid
LA5J689Medicare ID - Type Unspecified