Individual
EDWARD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1955 COFFEEN AVE, SHERIDAN, WY 82801-5713
(307) 672-0773
(307) 672-2739
Mailing address
1955 COFFEEN AVE, SHERIDAN, WY 82801-5713
(307) 672-0773
(307) 672-2739
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6604A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119617100
—
WY
Enumeration date
10/31/2006
Last updated
07/08/2008
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