Individual
DR. WILSON FULLA BERNALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
428 S DURBIN ST, SUITE 104, CASPER, WY 82601-2818
(307) 337-4284
(307) 462-0922
Mailing address
428 S DURBIN ST STE 104, CASPER, WY 82601-2818
(307) 337-4284
(307) 462-0922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
7632A
WY
207QA0505X
Adult Medicine Physician
Primary
C1-0007844
DE
Other
Enumeration date
05/02/2006
Last updated
12/08/2016
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