Individual
KEVIN WILLIAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5966 W CURTISIAN AVE, BOISE, ID 83704
(208) 302-5400
(208) 302-5455
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-5400
(208) 302-5455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2688
AZ
207R00000X
Internal Medicine Physician
Primary
O-1071
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110388
—
AZ
Enumeration date
08/30/2006
Last updated
08/13/2020
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