Individual
DR. PHILIP J. WILSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 556-7709
(573) 556-1709
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 556-7709
(573) 556-1709
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
R6C26
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106914
HEALTHLINK
MO
01
—
180032824
MEDICARE RAILROAD
MO
05
—
241745801
—
MO
01
—
9218
BCBS
MO
01
—
CP9089
RAILROAD GROUP
MO
Enumeration date
12/09/2005
Last updated
08/07/2008
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