# DAVID E WILSON MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** David E Wilson MD LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619421674
- **Authorized official:** DR. DAVID E WILSON M.D. (OWNER/PHYSICIAN)
- **Authorized official phone:** (816) 804-5223

## Contact information

- **Practice address:** 190 NE 91ST ST, KANSAS CITY, MO 64155-3329
- **Practice address phone:** (816) 804-5223
- **Mailing address:** 190 NE 91ST ST, KANSAS CITY, MO 64155-3329
- **Mailing address phone:** (816) 804-5223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | R4908 | MO | Yes |

## Other

- **Enumeration date:** 08/08/2016
- **Last updated:** 05/03/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 04489010 | BLUE CROSS OF KANSAS CITY INDIVIDUAL\# | MO |
| 01 | — | 110042554 | RAILROAD MEDICARE | MO |