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Individual

DR. VICTOR WARREN WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1229 E SEMINOLE ST, SUITE 230, SPRINGFIELD, MO 65804-2227
(417) 820-5610
(417) 820-5589
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
35088284
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
171572001
AR
05
204922801
MO
01
431560263
TRICARE WEST
Enumeration date
08/08/2006
Last updated
10/03/2014
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