Individual
DR. GREGORY L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9709 E 79TH ST, TULSA, OK 74133-4566
(918) 994-4000
(918) 994-4090
Mailing address
9709 E 79TH ST, TULSA, OK 74133-4566
(918) 994-4000
(918) 994-4090
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
2754
OK
207T00000X
Neurological Surgery Physician
Primary
2754
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100125210A
—
OK
Enumeration date
12/18/2006
Last updated
08/22/2022
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