Individual
TORRENCE M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1315 HOSPITAL DR, ST JOHNSBURY, VT 05819-9210
(802) 748-8141
Mailing address
PO BOX 905, NVRH SURGICAL GROUP, ST JOHNSBURY, VT 05819-0905
(802) 748-8141
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
31489
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320520700
—
MN
Enumeration date
01/19/2006
Last updated
02/05/2015
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