Individual
DR. BRANDON MARAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
1120 S UTICA AVE, SUITE G100, TULSA, OK 74104-4012
(918) 392-0175
(918) 392-0176
Mailing address
1120 S UTICA AVE, SUITE G100, TULSA, OK 74104-4012
(918) 392-0175
(918) 392-0176
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4976
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200304180A
—
OK
Enumeration date
09/10/2010
Last updated
05/06/2014
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