Individual
ALEX MARY LOGAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
201047
NC
207R00000X
Internal Medicine Physician
Primary
90103
SC
Other
Enumeration date
04/25/2014
Last updated
01/11/2024
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