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Individual

DAVID P WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
11219 N HIGHWAY 3, FORT JONES, CA 96032-9731
(530) 468-5766
(530) 842-9054
Mailing address
PO BOX 458, FORT JONES, CA 96032-0458
(530) 468-5766
(530) 842-9054

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
G37216
CA
207R00000X
Internal Medicine Physician
Primary
G37216
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G372162
CA
05
00G72161
CA
01
G37216
MEDICAL LICENSE
CA
Enumeration date
06/14/2005
Last updated
01/20/2012
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