Individual
JOHN STARKS WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1783 EL CAMINO REAL, BURLINGAME, CA 94010-3205
(650) 696-5515
Mailing address
P.O. BOX 6102, NOVATO, CA 94948-6102
(415) 884-3418
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G27483
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G274830
—
CA
01
—
300087076
RAILROAD MEDICARE
CA
Enumeration date
06/15/2006
Last updated
02/24/2009
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