Individual
ETHAN B. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3600 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 768-5021
Mailing address
PO BOX 48068, JACKSONVILLE, FL 32247-8068
(866) 898-7148
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
11896
OR
Other
Enumeration date
08/19/2006
Last updated
11/12/2007
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