Organization
DONALD R. WILSON, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD RICHARD WILSON M.D. (PRESIDENT)
(707) 965-2181
Entity
Organization
Contact information
Practice address
715 LINDA FALLS TER, ANGWIN, CA 94508-9684
(707) 965-2181
(707) 965-3576
Mailing address
PO BOX 714, ANGWIN, CA 94508-0714
(707) 965-2181
(707) 965-3576
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
A24934
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127551376
NPI(INDIVIDUAL)
—
05
—
OOA249340
—
CA
Enumeration date
08/20/2012
Last updated
08/20/2012
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