Individual
BRYAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-2869
(612) 916-8558
Mailing address
4708 BEAR CREEK LN, GIG HARBOR, WA 98335-8348
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101260836
VA
Other
Enumeration date
02/28/2014
Last updated
06/13/2019
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