Individual
DR. LARRY BRENT WILSHIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6 OFFICE PARK DR, JACKSONVILLE, NC 28546-7325
(910) 355-3937
(910) 347-6663
Mailing address
201 DAVID PL, JACKSONVILLE, NC 28540-4546
(910) 346-2085
(910) 347-6663
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
27869
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88165
BLUECROSS BLUESHIELD
NC
05
—
8988165
—
NC
Enumeration date
07/17/2006
Last updated
11/27/2007
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