Individual
JOHN ELWOOD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 PLEASANT ST, SUITE 400, DES MOINES, IA 50309-1416
(515) 241-5722
(515) 241-4403
Mailing address
1215 PLEASANT ST STE 400, DES MOINES, IA 50309-1418
(515) 241-5722
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
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