Individual
THOMAS J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5596A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
313044
WYOMING BLUE
—
01
—
5596A
MEDICAL LICENSE
WY
Enumeration date
08/18/2006
Last updated
03/07/2023
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