Individual
DR. BRIAN J WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
275 PONAHAWAI ST, SUITE 106, HILO, HI 96720-3074
(808) 961-0022
(808) 969-3852
Mailing address
275 PONAHAWAI ST, SUITE 106, HILO, HI 96720-3074
(808) 961-0022
(808) 969-3852
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
4143
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04734301
—
HI
Enumeration date
05/11/2006
Last updated
07/08/2007
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