Individual
DR. JEFFREY LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 C PHYSICIANS BLVD, GLASGOW, KY 42141-3462
(270) 651-2433
(270) 651-2949
Mailing address
102 PHYSICIANS BLVD, C, GLASGOW, KY 42141-1299
(270) 651-2433
(270) 651-2949
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
34426
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000065313
ANTHEM
KY
05
—
64344260
—
KY
01
—
P00629420
RAILROAD MEDICARE
—
Enumeration date
08/12/2005
Last updated
07/03/2014
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