Individual
DR. JEFFREY W WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MBA
Contact information
Practice address
2137 LAKESIDE DR., STE 104, LYNCHBURG, VA 24501-6806
(434) 382-1005
(434) 316-7138
Mailing address
2137 LAKESIDE DR., STE 104, LYNCHBURG, VA 24501-6806
(434) 382-1005
(434) 316-7138
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101030315
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110064347
MEDICARE RAILROAD
VA
05
—
1245202498
—
VA
01
—
541663754
CVFP INC
—
05
—
6047718
—
VA
Enumeration date
02/02/2006
Last updated
08/13/2013
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