Individual
JOHN ELWOOD WILSON
Active
Individual
JOHN ELWOOD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20335
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150953
—
IA
01
—
15095
BLUE SHIELD PROVIDER #
IA
01
—
20335
TRICARE PROVIDER #
IA
01
—
4268
MIDLANDS PROVIDER #
IA
01
—
IA0114
JOHN DEERE PROVIDER #
IA
Enumeration date
12/22/2005
Last updated
07/09/2007
Update your record
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