Individual
MR. CARY B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5900 STATE FARM DR STE 200, ROHNERT PARK, CA 94928-2149
(707) 559-7500
Mailing address
1179 N MCDOWELL BLVD, PETALUMA, CA 94954-6559
(707) 559-7500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
56256
CA
363A00000X
Physician Assistant
Primary
56256
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700067378
—
MT
Enumeration date
11/23/2007
Last updated
08/15/2024
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