Individual
LAWRENCE WOODROW WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5701 BALLOON FIESTA PARKWAY, CARE OF BLUE CROSS BLUE SHIELD OF NEW MEXICO, ALBUQUERQUE, NM 87113
(505) 816-2093
(505) 816-3608
Mailing address
5701 BALLOON FIESTA PARKWAY, CARE OF BLUE CROSS BLUE SHIELD OF NEW MEXICO, ALBUQUERQUE, NM 87113
(505) 816-2093
(505) 816-3608
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4269
ND
207Q00000X
Family Medicine Physician
Primary
99-332
NM
Other
Enumeration date
01/11/2007
Last updated
07/08/2007
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