Individual
ZACHARY DEWITT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
22 AREA REGIMENTAL AID STATION, 1ST MEDICAL BATTALION, CAMP PENDLETON, CA 92055-5657
(760) 725-3784
Mailing address
5552 GENESEE CT E APT 136, SAN DIEGO, CA 92111-3035
(423) 361-6112
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/30/2017
Last updated
06/30/2017
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