Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD-066989-L | PA |
NPI | 1013943968 |
---|---|
Provider Name | Dale F Wilson |
First Address | Fountainville, PA 18923-9608 |
Second Address | Doylestown, PA 18901-2554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 04/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34239 | (02) | PA |