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Individual

DR. STANLEY J WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3401 W 10TH ST, SEDALIA, MO 65301-2112
(660) 827-2883
(660) 827-1359
Mailing address
5005 DOGWOOD CIR, SEDALIA, MO 65301-8900
(660) 827-2883
(660) 827-1359

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
36325
MO
207Q00000X
Family Medicine Physician
Primary
36325
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201709516
MO
Enumeration date
04/28/2006
Last updated
03/02/2017
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