Individual
CHARLES RICHARD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6 WOODLAND RD STE 205, SAINT HELENA, CA 94574-9501
(707) 963-6111
(707) 963-6161
Mailing address
1400 29TH ST S, GREAT FALLS, MT 59405-5315
(406) 454-2171
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
47551
MT
208600000X
Surgery Physician
Primary
C164914
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03026446
—
NY
05
—
1022802
—
VT
Enumeration date
07/10/2007
Last updated
09/13/2019
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