Individual
RICHARD L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 PARKLAWN DR, STE 303, MIDWEST CITY, OK 73110-4211
(405) 733-3030
(405) 733-3865
Mailing address
2525 NW EXPRESSWAY, SUITE 610, OKLAHOMA CITY, OK 73112
(405) 286-9465
(405) 286-9462
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
14931
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100107140A
—
OK
Enumeration date
02/24/2006
Last updated
09/06/2012
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