Individual
DR. MATTHEW RYAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1185 DUNLAWTON AVE STE 100, PORT ORANGE, FL 32127-2906
(386) 756-7066
(386) 671-2820
Mailing address
PO BOX 947381, ATLANTA, GA 30394-7381
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
ME162821
FL
Other
Enumeration date
12/08/2006
Last updated
10/09/2023
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