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Individual
TIMOTHY R WILSON
Active
Individual
TIMOTHY R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101238898
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010199824
—
VA
01
—
C05516
MEDICARE GROUP NUMBER
—
Enumeration date
03/20/2006
Last updated
11/01/2010
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