Individual
BRANT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 W 86TH ST, DEPARTMENT OF EDUCATION, INDIANAPOLIS, IN 46260
(317) 338-2281
(317) 338-2851
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A141476
CA
Other
Enumeration date
03/26/2014
Last updated
06/18/2018
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