Individual
LAWRENCE H WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9500 MENTOR AVE, SUITE 100, MENTOR, OH 44060-8713
(440) 352-4880
(440) 352-3629
Mailing address
9500 MENTOR AVE, SUITE 100, MENTOR, OH 44060-8713
(440) 352-4880
(440) 352-3629
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35045873
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0471449
—
OH
Enumeration date
03/01/2006
Last updated
01/12/2015
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