Individual
RICHARD BOULWARE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2407 RUTH HENTZ AVE, PANAMA CITY, FL 32405-2259
(850) 522-5022
(850) 387-0807
Mailing address
11945 SAN JOSE BLVD STE 300, JACKSONVILLE, FL 32223-1627
(904) 396-1725
(904) 396-4893
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME76205
FL
Other
Enumeration date
10/26/2005
Last updated
12/29/2020
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