Individual
DR. JACK EDWARD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 WALNUT ST STE 100, LEMOYNE, PA 17043
(717) 761-4141
(717) 761-1456
Mailing address
409 S 2ND ST, SUITE 2F, HARRISBURG, PA 17104-1612
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD025597E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000971496
—
PA
Enumeration date
01/30/2006
Last updated
01/23/2021
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