# DR. JOHN WILSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1144370420
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | C2-0007386 | DE | — |
| 207Q00000X | Family Medicine Physician | H0061880 | MD | — |
| 207Q00000X | Family Medicine Physician | OS003902-L | PA | Yes |

## Other

- **Enumeration date:** 01/11/2007
- **Last updated:** 07/09/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0614036 | — | PA |
| 01 | — | 606346 | BLUE SHIELD | PA |