Individual
SAMUEL JEROD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 E PRIMROSE ST, SPRINGFIELD, MO 65807-5154
(314) 269-6000
Mailing address
12324 MATTHEWS LN, SAINT LOUIS, MO 63127-1344
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2024004739
MO
Other
Enumeration date
02/06/2024
Last updated
02/06/2024
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