Individual
DR. KEVIN J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3140 W MILANO DR, SUITE 150, MERIDIAN, ID 83646-7290
(208) 887-4775
(208) 888-1344
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 887-4775
(208) 888-1344
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M9669
ID
Other
Enumeration date
05/16/2006
Last updated
08/21/2012
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