Individual
DR. BRIAN GUY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2619 CENTENNIAL BLVD STE 103, TALLAHASSEE, FL 32308-0590
(850) 656-7720
(850) 656-7729
Mailing address
PO BOX 13058, TALLAHASSEE, FL 32317-3058
(850) 656-7720
(850) 656-7729
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
MD.15516R
LA
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
ME82516
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2622203
—
FL
Enumeration date
05/12/2006
Last updated
05/02/2011
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