Individual
MR. BRENT C WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4300 W MEMORIAL RD, OKLAHOMA CITY, OK 73120-8304
(405) 752-3715
Mailing address
4401 W MEMORIAL RD, SUITE 140, OKLAHOMA CITY, OK 73134-1785
(405) 752-3162
(405) 936-5211
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
17280
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100213520B
—
OK
Enumeration date
05/01/2006
Last updated
05/21/2014
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