Individual
DR. CHARLES WILSON
Active
Individual
DR. CHARLES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD09689
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116012
MARION POLK CHP
—
05
—
116012
—
OR
05
—
8302143
—
WA
01
—
A020
CHAMPUS
—
01
—
A44718
PROVIDENCE
—
01
—
FM1W751
PACC
—
01
—
M400711
PACIFIC SOURCE
—
05
—
XPY049920
—
CA
Enumeration date
09/05/2006
Last updated
12/19/2007
Update your record
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