Individual
GEORGE ANDREW WILSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1530 N 7TH ST, SUITE 107, TERRE HAUTE, IN 47807-1057
(812) 238-4900
(812) 238-4921
Mailing address
1530 N 7TH ST, SUITE 107, TERRE HAUTE, IN 47807-1057
(812) 238-4900
(812) 238-4921
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01057579A
IN
207T00000X
Neurological Surgery Physician
Primary
01057579A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000295844
BLUE CROSS
IN
05
—
200452000A
—
IN
01
—
ICHIA
ICHIA
IN
01
—
P00058804
PALM
IN
Enumeration date
12/16/2005
Last updated
08/23/2019
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