Organization
MATTHEW THOMAS WILSON MD FACS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW THOMAS WILSON M.D. (PRESIDENT)
(310) 777-8830
Entity
Organization
Contact information
Practice address
436 N. BEDFORD DRIVE, SUITE 103, BEVERLY HILLS, CA 90210
(310) 777-8830
Mailing address
P.O. BOX 892649, TEMECULA, CA 92589
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
A53944
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A539440
—
CA
Enumeration date
07/06/2009
Last updated
02/08/2012
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