Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 25MA04259200 | NJ |
NPI | 1700811494 |
---|---|
Provider Name | Dorian J. Wilson |
First Address | Newark, NJ 07107-3000 |
Second Address | Newark, NJ 07107-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2008505 | (05) | NJ |
D19909 | (02) |