Individual
DR. JAMES M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MS
Contact information
Practice address
200 MEDICAL PLAZA, STE.# 365, LOS ANGELES, CA 90045
(310) 206-7662
(310) 794-6553
Mailing address
200 MEDICAL PLZ, 365 A& B, LOS ANGELES, CA 90095-0001
(310) 206-7662
(310) 794-6553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A75466
CA
207RN0300X
Nephrology Physician
Primary
A75466
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912943168
—
CA
Enumeration date
06/22/2006
Last updated
05/29/2018
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