Individual
PHILIP JOSEPH WILSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 556-7709
(573) 556-1709
Mailing address
1241 W. STADIUM BLVD., JEFFERSON CITY, MO 65109-6023
(573) 556-7709
(573) 556-1709
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2017021706
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200029781
—
MO
Enumeration date
06/28/2013
Last updated
07/21/2022
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