Individual
JAMISON L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3499
(765) 747-4374
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01063480A
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01063480A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200858000
—
IN
01
—
P00966894
RAILROAD MEDICARE
IN
Enumeration date
05/04/2007
Last updated
02/23/2021
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