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Contact Information

MIRIAM J WILBON, PA
3330 MASONIC DR
ALEXANDRIA, LA71301-3841
 Phone: 318-487-1122
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical

363AM0700X 97 Physician Assistant
 

Medical Technologist

246QM0706X
 

Physician Assistant

363A00000X 97 Physician Assistant
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for MIRIAM J WILBON · (Female)

NPI Number 1629249347
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 03/20/2008
Last updated 02/22/2017 - About 9 years ago
Sole proprietor 1 Yes
Identifiers
  • LA License # A10315
  • LA License # G02542
  • LA Medicaid 1886203
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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