Individual
BRANDON JAMES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
USCG BASE KODIAK ROCKMORE-KING CLINIC, 200 ALBATROSS AVE BLDG N-46, KODIAK, AK 99615-6810
(907) 487-5757
Mailing address
37 CEDARWOOD CT, PHENIX CITY, AL 36870-4801
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01268
RI
Other
Enumeration date
02/09/2019
Last updated
08/20/2020
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