Individual
JAMES DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
350 HOSPITAL WAY, SUITE 100, SOMERSET, KY 42503-2872
(606) 451-2662
(606) 451-2641
Mailing address
350 HOSPITAL WAY, SUITE 100, SOMERSET, KY 42503-2872
(606) 451-2662
(606) 451-2641
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28922
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054066
ANTHEM
—
01
—
1183698
CHA
—
01
—
5012148
AETNA
—
01
—
5125851
CCN
—
05
—
64289226
—
KY
01
—
C92457
CUMBERLAND HEALTHCARE
—
Enumeration date
02/14/2006
Last updated
04/20/2008
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