Individual
DR. RICHARD C WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1515 DR MARTIN LUTHER KING JR BLVD, MELBOURNE, FL 32901-2946
(321) 723-3500
(321) 723-1945
Mailing address
1515 DR MARTIN LUTHER KING JR BLVD, MELBOURNE, FL 32901-2946
(321) 723-3500
(321) 723-1945
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016003144
IL
213E00000X
Podiatrist
421
CO
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO1322
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041009800
—
FL
01
—
87733
BCBS
FL
Enumeration date
11/30/2005
Last updated
05/12/2023
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