Individual
TIMOTHY P WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
115B S ILLINOIS AVE, OAK RIDGE, TN 37830-6202
(865) 483-4040
Mailing address
1835 ROYAL HARBOR DR, KNOXVILLE, TN 37922-7214
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD26476
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3096650
MEDICARE
TN
05
—
3096655
—
TN
01
—
CA7018
RAILROAD MEDICARE
TN
Enumeration date
06/27/2006
Last updated
10/11/2007
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