Individual
JOSEPH F WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
29 NW 1ST LN, LAMAR, MO 64759-8105
(417) 681-5266
(417) 681-5505
Mailing address
29 NW 1ST LN, LAMAR, MO 64759-8105
(417) 681-5266
(417) 681-5505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R8N54
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010054184
RR MEDICARE
—
01
—
100616
ANTHEM
MO
01
—
1275730160
MEDICARE GROUP NUMBER
MO
05
—
242951002
—
MO
Enumeration date
07/03/2006
Last updated
07/27/2012
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