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Organization
DAVID E WILSON MD LLC
Active
Organization
DAVID E WILSON MD LLC
Active
Other names
David E Wilson MD LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID E WILSON M.D. (OWNER/PHYSICIAN)
(816) 804-5223
Entity
Organization
Contact information
Practice address
190 NE 91ST ST, KANSAS CITY, MO 64155-3329
(816) 804-5223
Mailing address
190 NE 91ST ST, KANSAS CITY, MO 64155-3329
(816) 804-5223
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R4908
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04489010
BLUE CROSS OF KANSAS CITY INDIVIDUAL#
MO
01
—
110042554
RAILROAD MEDICARE
MO
Enumeration date
08/08/2016
Last updated
05/03/2024
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