Individual
DR. THOMAS JEROME WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 RIVERVIEW AVE, WAUKESHA, WI 53188-3632
(262) 548-7666
(262) 548-7656
Mailing address
500 RIVERVIEW AVE, WAUKESHA, WI 53188-3632
(262) 548-7666
(262) 548-7656
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
21107
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30153500
—
WI
Enumeration date
01/09/2007
Last updated
07/08/2007
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