Individual
RONALD L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4620 VILLAGE SQUARE DRIVE, SUITE 101, PADUCAH, KY 42001-7501
(270) 442-8575
(270) 442-8783
Mailing address
PO BOX 734839, CHICAGO, IL 60673-4839
(502) 253-4900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22453
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062924
BLUE CROSS ID NUMBER
KY
05
—
64224538
—
KY
Enumeration date
03/09/2006
Last updated
12/01/2020
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