Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MD.15516R | LA |
N | 207RA0201X | Internist - Allergy & Immunology | ME82516 | FL |
NPI | 1760433247 |
---|---|
Provider Name | Dr. Brian Guy Wilson |
First Address | Tallahassee, FL 32317-3058 |
Second Address | Tallahassee, FL 32308-0590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 02/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2622203 | (05) | FL |
H47012 | (02) |