Individual
MR. MATTHEW S. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4696
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40386000
—
WI
Enumeration date
04/20/2007
Last updated
08/22/2019
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