Individual
ZECHARIAH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 E ELM ST # 201, CALDWELL, ID 83605-4857
(208) 514-2528
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-14112
ID
207Q00000X
Family Medicine Physician
MRM-1581
ID
207QS0010X
Sports Medicine (Family Medicine) Physician
M-14112
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104274950
—
ID
Enumeration date
06/01/2016
Last updated
11/05/2025
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