Individual
MARY E WILSON
Active
Individual
MARY E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25660
IA
207RI0200X
Infectious Disease Physician
Primary
25660
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0242065
—
IA
01
—
24206
WELLMARK BCBS
IA
Enumeration date
11/18/2005
Last updated
06/09/2015
Update your record
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