Organization
THOMAS L WILSON M D LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES STOTT WILSON MD (PHYSICIAN)
(217) 243-1865
Entity
Organization
Contact information
Practice address
814 W STATE, JACKSONVILLE, IL 62650
(217) 243-1865
(217) 243-6765
Mailing address
814 W STATE, JACKSONVILLE, IL 62650
(217) 243-1865
(217) 243-6765
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
060001084
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036043460
—
IL
Enumeration date
04/12/2006
Last updated
06/01/2011
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