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Individual
CHARLES CLINTON WILSON
Active
Individual
CHARLES CLINTON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101058559
VA
207Q00000X
Family Medicine Physician
G22781
CA
Other
Enumeration date
01/31/2007
Last updated
07/15/2009
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