Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD-47193 | IA |
N | 207P00000X | Emergency Physician | R73951 | AZ |
N | 207PP0204X | Pediatric Emergency Physician | MD-47193 | IA |
N | 208000000X | Pediatrician | R73951 | AZ |
NPI | 1134567415 |
---|---|
Provider Name | Dr. Bryan Zoran Wilson |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 16/07/2020 |