Individual
DR. EUGENE WILEY WILSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
84 MALLET HILL CT, COLUMBIA, SC 29223-3126
(803) 509-0456
Mailing address
84 MALLET HILL CT, COLUMBIA, SC 29223-3126
(803) 509-0456
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
02002999A
IN
Other
Enumeration date
11/01/2005
Last updated
03/20/2013
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