Individual
CAROL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 5TH ST S, DEPT 6590, ST PETERSBURG, FL 33701-4804
(727) 767-7739
Mailing address
601 5TH ST S, DEPT 6590, ST PETERSBURG, FL 33701-4804
(727) 767-7739
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
200700845
NC
208000000X
Pediatrics Physician
Primary
ME79468
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125195254A
—
GA
05
—
265213700
—
FL
01
—
78648
BCBS
FL
05
—
891451E
—
NC
Enumeration date
07/17/2006
Last updated
09/16/2013
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