Individual
GARY L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5500 E KELLOGG DR, DEPARTMENT OF RADIOLOGY, WICHITA, KS 67218-1607
(970) 250-2891
Mailing address
5500 E KELLOGG DR, DEPARTMENT OF RADIOLOGY, WICHITA, KS 67218-1607
(970) 250-2891
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G-1584
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100384790A
—
KS
Enumeration date
03/28/2006
Last updated
05/21/2013
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