Individual
DR. DERIC MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1010 PLYMOUTH RD, YORK, PA 17402-3864
(717) 851-1800
(717) 851-1810
Mailing address
3421 CONCORD RD, YORK, PA 17402-9001
(717) 851-1800
(717) 851-1810
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS014303
PA
207Q00000X
Family Medicine Physician
OT014074
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102915087
—
PA
Enumeration date
12/28/2006
Last updated
08/08/2014
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