Individual
JEFFREY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 RESERVOIR AVE, SUITE 102, CRANSTON, RI 02910-4448
(401) 943-6910
(401) 946-5130
Mailing address
70 GLEN AVE, CRANSTON, RI 02905-3702
(401) 941-5053
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10483
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0102498
UNITED HEALTHCARE
RI
01
—
104830
TUFTS
RI
01
—
23507-1
BLUE CROSS
RI
01
—
409056
BLUE CHIP
RI
01
—
62308
CIGNA
RI
Enumeration date
09/09/2005
Last updated
04/11/2016
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