Individual
GRANT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
802 KENYON RD, FORT DODGE, IA 50501-5740
(515) 573-3101
Mailing address
802 KENYON RD, FORT DODGE, IA 50501-5740
(515) 573-3101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
079688
IA
Other
Enumeration date
09/02/2015
Last updated
09/02/2015
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