Individual
DWAYNE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2454 CAMP TRAVIS, FORT SAM HOUSTON, TX 78234-7671
(401) 419-6040
Mailing address
PO BOX 340773, FORT SAM HOUSTON, TX 78234-0773
(401) 419-6040
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
037212
CT
207P00000X
Emergency Medicine Physician
11620
RI
207P00000X
Emergency Medicine Physician
210137
NY
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
210137
NY
2083A0100X
Aerospace Medicine Physician
210137
NY
Other
Enumeration date
07/26/2006
Last updated
08/07/2010
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