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Individual

JASON WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3501 CRANBERRY BLVD, WESTON, WI 54476-5213
(715) 393-1000
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
41527
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
34382000
WI
Enumeration date
09/20/2006
Last updated
02/10/2012
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