Individual
CODY R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2380 N 400 E STE C, NORTH LOGAN, UT 84341-1756
(435) 753-7337
(435) 750-6779
Mailing address
2380 N 400 E STE C, NORTH LOGAN, UT 84341-1756
(435) 753-7337
(435) 750-6779
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
6025
NE
208000000X
Pediatrics Physician
Primary
8849510-1204
UT
Other
Enumeration date
10/16/2009
Last updated
10/02/2019
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