Individual
DR. IAN FITZSIMMONS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10000 BAY PINES BLVD, BAYPINES, FL 33744
(727) 398-6661
Mailing address
4836 VENETIAN PLACE NE, ST PETERSBURG, FL 33703
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
ME 84966
FL
Other
Enumeration date
04/27/2007
Last updated
07/08/2007
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