Individual
MARY KATE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
206 ASHOURIAN AVE STE 215, ST AUGUSTINE, FL 32092-5107
(904) 296-0098
Mailing address
PO BOX 11407, BIRMINGHAM, AL 35246-8575
(864) 359-1308
(239) 496-3939
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
166739
FL
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
ME166739
FL
Other
Enumeration date
04/08/2020
Last updated
04/01/2026
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