Individual
DR. WILLIAM LE ROY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5565 GROSSMONT CENTER DR, BLDG. 3, SUITE 540, LA MESA, CA 91942-3020
(619) 460-2700
(619) 460-2702
Mailing address
5565 GROSSMONT CENTER DR, BLDG. 3, SUITE 540, LA MESA, CA 91942-3020
(619) 460-2700
(619) 460-2702
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
G44872
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G448720
—
CA
Enumeration date
09/13/2005
Last updated
02/26/2021
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