Organization
CHARLES A. WILSON D.O., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES ASHLEY WILSON D.O. (SOLE MEMBER)
(808) 744-1906
Entity
Organization
Contact information
Practice address
91-2139 FORT WEAVER RD, SUITE 213, EWA BEACH, HI 96706-3607
(808) 677-8008
(808) 677-8007
Mailing address
91-2139 FORT WEAVER RD, SUITE 213, EWA BEACH, HI 96706-3607
(808) 677-8008
(808) 677-8007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DOS 1154
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
597081
—
HI
Enumeration date
08/11/2010
Last updated
08/11/2010
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