Individual
DERRON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13345 ILLINOIS ST, CARMEL, IN 46032-3318
(317) 396-1300
(317) 870-2728
Mailing address
13345 ILLINOIS ST, CARMEL, IN 46032-3318
(317) 396-1300
(317) 870-2728
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
01047150A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200313770B
—
IN
Enumeration date
12/07/2005
Last updated
02/22/2021
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