Individual
ANDREW WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6600 MADISON ST, NEW PORT RICHEY, FL 34652-1971
(727) 838-6186
Mailing address
1 DAVIS BLVD, SUITE 504, TAMPA, FL 33606-3463
(813) 627-5931
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME116018
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/24/2010
Last updated
06/19/2013
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