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Individual

DR. JOHN MARSHALL WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1850 BLUEGRASS AVE, LOUISVILLE, KY 40215
(502) 361-6617
(502) 361-6637
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 361-6617
(502) 361-6637

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
47643
KY
207L00000X
Anesthesiology Physician
TP926
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100323720
KY
01
K153505
MEDICARE PIN
KY
Enumeration date
10/25/2010
Last updated
08/29/2019
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