Individual
DR. GARY A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
311 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2781
(386) 947-4650
(386) 947-4690
Mailing address
311 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2781
(386) 947-4650
(386) 947-4690
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
34858
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0276915
—
IA
Enumeration date
06/27/2005
Last updated
07/10/2009
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