Individual
TIMOTHY O WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
25774
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160006908
RAILROAD MEDICARE
MN
05
—
610218200
—
MN
Enumeration date
01/24/2006
Last updated
02/26/2014
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