Individual
BENJAMIN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 S ASH ST, NEVADA, MO 64772-3223
(417) 667-3355
Mailing address
627 S ASH ST, NEVADA, MO 64772-3218
(417) 667-6800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2015010966
MO
207Q00000X
Family Medicine Physician
P5148
TX
Other
Enumeration date
04/08/2011
Last updated
03/11/2016
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