Individual
MR. GAYLE RAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
289 E ELLENDALE, SUITE 503, DALLAS, OR 97338
(503) 623-8826
(503) 623-8739
Mailing address
PO BOX 26, DALLAS, OR 97338
(503) 623-8826
(503) 623-8739
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD09317
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004460
—
OR
Enumeration date
12/28/2006
Last updated
07/08/2007
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