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Individual

MARTHA CLINTON WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
207 1ST ST S, NAMPA, ID 83651-3703
(208) 466-7869
(208) 466-5359
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 322-7018

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-1127
ID

Other

Enumeration date
06/23/2010
Last updated
11/12/2015
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