Individual
MATTHEW WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 S 23RD ST, BOISE, ID 83702-9100
(208) 344-3512
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 467-4431
(208) 466-5359
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-14743
ID
Other
Enumeration date
04/06/2015
Last updated
08/26/2019
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