Individual
DR. JOHN R WILSON
Active
Individual
DR. JOHN R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
8411
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000091778
BLUECROSS BLUESHIELD
MT
05
—
108160
—
MT
05
—
114452900
—
WY
01
—
200033018
RR MEDICARE
MT
Enumeration date
08/19/2005
Last updated
04/29/2008
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