Individual
DAVID JAMES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
(918) 458-3511
Mailing address
27 GARY CT, LAKE OZARK, MO 65049-6716
(573) 365-7241
(918) 458-3511
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01325
IA
208600000X
Surgery Physician
2003
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100174400A
—
OK
05
—
150600003
—
AR
Enumeration date
08/30/2006
Last updated
01/25/2011
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