# BRIAN WILSON MD L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134315005
- **Authorized official:** DR. BRIAN J WILSON MD (PEDIATRICIAN)
- **Authorized official phone:** (808) 961-0022

## Contact information

- **Practice address:** 275 PONAHAWAI ST, SUITE 106, HILO, HI 96720-3074
- **Practice address phone:** (808) 961-0022
- **Practice address fax:** (808) 969-3852
- **Mailing address:** 275 PONAHAWAI ST, SUITE 106, HILO, HI 96720-3074
- **Mailing address phone:** (808) 961-0022
- **Mailing address fax:** (808) 969-3852

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | 4143 | HI | Yes |

## Other

- **Enumeration date:** 09/24/2007
- **Last updated:** 09/24/2007