Individual
JON JAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3480 WAKE FOREST RD, SUITE 208, RALEIGH, NC 27609-7376
(919) 781-4541
(919) 781-4812
Mailing address
5213 S ALSTON AVE, DURHAM, NC 27713-4430
(919) 684-8111
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
200200477
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132NE
BLUE CROSS/BLUE SHIELD
NC
05
—
89132NE
—
NC
Enumeration date
06/29/2006
Last updated
05/08/2012
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