Individual
MR. DEREK EDWARD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
800 W LAUREL ST, INDEPENDENCE, KS 67301-3211
(620) 332-3280
(620) 332-3281
Mailing address
PO BOX 845, INDEPENDENCE, KS 67301-0845
(620) 332-3280
(620) 332-3281
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1501140
KS
Other
Enumeration date
11/01/2006
Last updated
01/14/2010
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