Individual
DR. CLEMENTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
900 W 49TH ST STE 308, HIALEAH, FL 33012-3435
(305) 266-2929
(305) 558-9039
Mailing address
8750 NW 36TH ST STE 300, DORAL, FL 33178-2499
(305) 262-1610
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9100865
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9100865
PHYSICIAN ASSISTANT
FL
Enumeration date
05/12/2006
Last updated
11/27/2017
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