Individual
DR. JOHN DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
495 SW RAMSEY AVE, GRANTS PASS, OR 97527-5681
(541) 476-6644
Mailing address
495 SW RAMSEY AVE, GRANTS PASS, OR 97527-5681
(541) 476-6644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
150495
OR
207QA0505X
Adult Medicine Physician
MD37095
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500622415
—
OR
Enumeration date
11/18/2008
Last updated
07/06/2010
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