Individual
DR. JASON PAUL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11803 JEFFERSON AVE STE 235, NEWPORT NEWS, VA 23606-2565
(757) 594-1806
(757) 510-9079
Mailing address
2995 DREW ST, CLEARWATER, FL 33759-3012
(727) 315-7496
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101248811
VA
208600000X
Surgery Physician
251807
NY
208600000X
Surgery Physician
ME127549
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018648100
—
FL
05
—
03101360
—
NY
Enumeration date
10/17/2006
Last updated
03/07/2024
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