Individual
GARY J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Mailing address
2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
(877) 498-4490
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2014-02239
NC
207VG0400X
Gynecology Physician
2014-02239
NC
207VX0000X
Obstetrics Physician
2014-02239
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3122191
—
MA
Enumeration date
05/19/2006
Last updated
04/15/2021
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