Individual
JDEE RYAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 E ALICE ST, STATE HOSPITAL SOUTH, BLACKFOOT, ID 83221
(208) 785-1200
(208) 785-8516
Mailing address
700 E ALICE ST, STATE HOSPITAL SOUTH, BLACKFOOT, ID 83221
(208) 785-1200
(208) 785-8516
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M9137
ID
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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