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Organization

BRIAN WILSON MD L.L.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRIAN J WILSON MD (PEDIATRICIAN)
(808) 961-0022
Entity
Organization

Contact information

Practice address
275 PONAHAWAI ST, SUITE 106, HILO, HI 96720-3074
(808) 961-0022
(808) 969-3852
Mailing address
275 PONAHAWAI ST, SUITE 106, HILO, HI 96720-3074
(808) 961-0022
(808) 969-3852

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
4143
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04734301
IA
Enumeration date
09/24/2007
Last updated
09/24/2007
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