Individual
WAYNE TILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2904 GILL AVE, LAWRENCE, KS 66047-3038
(785) 841-9419
Mailing address
2904 GILL AVE, LAWRENCE, KS 66047-3038
(785) 841-9419
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
17945
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17945
MEDICAL LICENSE NUMBER
KS
Enumeration date
09/17/2006
Last updated
07/08/2007
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