Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 44482 | AZ |
NPI | 1093995052 |
---|---|
Provider Name | David Aaron Wilson |
First Address | Gilbert, AZ 85297-0424 |
Second Address | Gilbert, AZ 85297-0424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
44482 | ARIZONA MEDICA BOARD LICENSE (01) | AZ |
804847 | (05) | AZ |