Individual
RICKEY L. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1401 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1707
(563) 421-1785
(563) 421-2918
Mailing address
1401 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1707
(563) 421-1785
(563) 421-2918
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01034948A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000351695
ANTHEM
—
01
—
11196050
CAQH
—
Enumeration date
07/03/2006
Last updated
09/16/2011
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