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Individual
DR. REX DUANE WILSON
Active
Individual
DR. REX DUANE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G86692
CA
208M00000X
Hospitalist Physician
Primary
G86692
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G866920
—
CA
01
—
124076900
WORKERS COMP PROVIDER #
CA
01
—
G86692
LICENSE NUMBER
CA
Enumeration date
06/13/2005
Last updated
03/07/2023
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