Individual
JASON WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 DAVIS BLVD, TAMPA, FL 33606-3463
(813) 843-2110
Mailing address
2540 W MARYLAND AVE, TAMPA, FL 33629-6233
(813) 843-2110
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME105890
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003616000
—
FL
01
—
14E16
BSFL
FL
Enumeration date
06/25/2008
Last updated
04/25/2022
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