Individual
DR. CHARLES STOTT WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
814 WEST STATE, JACKSONVILLE, IL 62650
(217) 243-1865
(217) 243-6765
Mailing address
814 WEST STATE, JACKSONVILLE, IL 62650
(217) 243-1865
(217) 243-6765
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036043460
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036043460
—
IL
Enumeration date
04/04/2006
Last updated
09/11/2008
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