Individual
MICHAEL R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1300 E ZION RD, FAYETTEVILLE, AR 72703-5015
(479) 521-8980
(479) 521-8982
Mailing address
1300 E ZION RD, FAYETTEVILLE, AR 72703-5015
(479) 521-8980
(479) 521-8982
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
E-3255
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146880001
—
AR
Enumeration date
04/28/2006
Last updated
09/08/2008
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