Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 28933 | AL |
N | 207X00000X | Orthopaedic Surgeon | ME84712 | FL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 28933 | AL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 28933 | AL |
NPI | 1053472712 |
---|---|
Provider Name | Dr. Charles Henry Wilson IV |
First Address | Mobile, AL 36689-6144 |
Second Address | Mobile, AL 36608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 09/02/2012 |