Individual
JOHN ALLEN WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-2907
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-2907
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
9300847
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140007849
RR MEDICARE
—
05
—
211618000
—
WV
01
—
48851
MEDCOST
—
01
—
5514436
AETNA
—
05
—
6100821
—
VA
01
—
6294
PARTNERS
—
05
—
7988337
—
NC
01
—
88337
BCBS
—
05
—
Q00840
—
SC
Enumeration date
01/19/2006
Last updated
08/23/2010
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