Individual
GREGORY J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2505 GREEN TECH DR STE C, STATE COLLEGE, PA 16803-2316
(814) 235-0484
(814) 234-7587
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2010015957
MO
207R00000X
Internal Medicine Physician
OS-013257
PA
207RR0500X
Rheumatology Physician
Primary
O-0777
ID
207RR0500X
Rheumatology Physician
OS013257
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101334728
—
PA
05
—
1013347280004
—
PA
05
—
1669406799
—
ID
Enumeration date
07/11/2006
Last updated
06/07/2023
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