Basic Information
| Provider Information | |||||||||
| NPI: | 1093745697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARHAM | ||||||||
| FirstName: | WILSON | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2802 KILPATRICK BLVD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188556282 | ||||||||
| FaxNumber: | 3188556424 | ||||||||
| Practice Location | |||||||||
| Address1: | 2802 KILPATRICK BLVD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188556282 | ||||||||
| FaxNumber: | 3188556424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 020809 | LA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.