Individual
BRIAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3501 HEALTH CENTER BLVD, ESTERO, FL 34135-8127
(239) 949-1050
(239) 949-6111
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 949-1050
(239) 949-6111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME99039
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003810300
—
FL
Enumeration date
07/05/2006
Last updated
03/30/2021
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