Individual
JODY M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1401 E VAN BUREN AVE, MCALESTER, OK 74501-4245
(918) 421-8410
(918) 421-8772
Mailing address
1401 E VAN BUREN AVE, MCALESTER, OK 74501-4245
(918) 421-8410
(918) 421-8772
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25350
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037735003
—
TX
Enumeration date
02/23/2006
Last updated
11/20/2018
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