Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC | CA |
Y | 213ER0200X | Radiology | DC | CA |
NPI | 1568525681 |
---|---|
Provider Name | Donald Kerry Wilson |
First Address | Davis, CA 95616-3626 |
Second Address | Davis, CA 95616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 14/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T04368 | (02) |