Individual
SAMUEL M. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
210 W 300 N, ROOSEVELT, UT 84066-2336
(435) 722-4691
(435) 722-9291
Mailing address
210 W 300 N, ROOSEVELT, UT 84066-2336
(435) 725-7448
(435) 722-9291
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5131797-1204
UT
207N00000X
Dermatology Physician
OP60440339
WA
Other
Enumeration date
07/10/2010
Last updated
11/02/2021
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