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Individual
MARK COOPER WILSON
Active
Individual
MARK COOPER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD MPH
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35455
IA
208M00000X
Hospitalist Physician
Primary
MD-35455
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04278
WELLMARK BCBS
IA
Enumeration date
11/21/2005
Last updated
04/09/2025
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