Individual
DR. WILLIAM CASSIDY WILSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 E PARRISH AVE BLDG D, OWENSBORO, KY 42303-1458
(270) 926-8171
Mailing address
660 S EUCLID AVE, CB 8131, SAINT LOUIS, MO 63110-1010
(314) 362-7200
(314) 747-4189
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
2019009534
MO
2085R0202X
Diagnostic Radiology Physician
2019009534
MO
2085R0202X
Diagnostic Radiology Physician
Primary
53142
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200067605
—
MO
05
—
ENROLLED
—
IL
Enumeration date
04/10/2014
Last updated
04/03/2025
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