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Individual

DR. MARK W. WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1001 POTRERO AVENUE, SFGH DEPARTMENT OF RADIOLOGY, ROOM 1X57, SAN FRANCISCO, CA 94110-2204
(415) 353-1300
(415) 353-8570
Mailing address
5 BURNETT AVENUE NORTH, APT. #1, SAN FRANCISCO, CA 94131
(415) 642-9196

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G74073
CA
2085R0204X
Vascular & Interventional Radiology Physician
G74073
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G740730
CA
Enumeration date
06/12/2006
Last updated
07/23/2008
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