Organization
CALLAWAY INTERNAL MEDICINE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK M WILSON M.D. (PHYSICIAN)
(573) 642-4242
Entity
Organization
Contact information
Practice address
2613 FAIRWAY DR, SUITE D, FULTON, MO 65251-3936
(573) 642-4242
Mailing address
2613 FAIRWAY DR, SUITE D, FULTON, MO 65251-3936
(573) 642-4242
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
112907
MO
174400000X
Specialist
113229
MO
Other
Enumeration date
10/24/2006
Last updated
08/22/2020
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