Individual
DR. KEVIN DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3300 HIGH ST, SUITE 6, PORTSMOUTH, VA 23707-3321
(757) 399-4341
(757) 393-0743
Mailing address
3300 HIGH ST, SUITE 6, PORTSMOUTH, VA 23707-3321
(757) 399-4341
(757) 393-0743
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101035314
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027301
ANTHEM BC BS
VA
01
—
22116
OPTIMA HEALTH
VA
Enumeration date
08/09/2006
Last updated
07/08/2007
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