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Individual

BRIAN CLAUD WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
197 S HERLONG AVE, ROCK HILL, SC 29732-3427
(803) 366-9000
(803) 366-9200
Mailing address
197 S HERLONG AVE, ROCK HILL, SC 29732-3427
(803) 366-9000
(803) 366-9200

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
15101
SC
207Y00000X
Otolaryngology Physician
39899
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
151016
SC
Enumeration date
08/09/2005
Last updated
05/27/2008
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