Individual
GRACE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1705 E BROADWAY STE 280, COLUMBIA, MO 65201-7185
(573) 815-7119
(573) 815-7116
Mailing address
1705 E BROADWAY STE 280, COLUMBIA, MO 65201-7185
(573) 815-7119
(573) 815-7116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2015017097
MO
207RP1001X
Pulmonary Disease Physician
Primary
2021030232
MO
Other
Enumeration date
06/05/2015
Last updated
10/25/2021
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