Individual
JOHN DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
931 PENNSYLVANIA AVE, OTTUMWA PEDIATRICS, OTTUMWA, IA 52501
(641) 684-3000
(641) 684-2469
Mailing address
312 E ALTA VISTA, ORHC CLINICS, OTTUMWA, IA 52501
(641) 684-3000
(641) 684-2469
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36914
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000576001
—
DE
05
—
0746719
—
IA
01
—
28375
BCBS OF IA
IA
01
—
JA0171
JOHN DEERE HEALTH
IA
Enumeration date
07/18/2005
Last updated
10/24/2007
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