Individual
DR. RUSSELL L. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 DUFF AVE, AMES, IA 50010-3014
(515) 239-4456
(515) 239-4761
Mailing address
1215 DUFF AVE, AMES, IA 50010-3014
(515) 239-4456
(515) 239-4761
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
23024
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196311
—
IA
Enumeration date
11/15/2005
Last updated
09/12/2012
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