Individual
PETER S WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4704 WHITESBURG DR SW STE 200, HUNTSVILLE, AL 35802
(256) 880-4510
(256) 880-4512
Mailing address
4704 WHITESBURG DR SW STE 200, HUNTSVILLE, AL 35802-1681
(256) 533-7064
(256) 704-0115
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD.15425
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000070292
—
AL
01
—
020040119
RR MEDICARE
AL
Enumeration date
10/12/2005
Last updated
08/14/2018
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