Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 36985 | VA |
NPI | 1386741742 |
---|---|
Provider Name | Dr. David Cole Wilson III |
First Address | Staunton, VA 24402-4000 |
Second Address | Staunton, VA 24402-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7165030 | (05) | VA |
B06572 | (02) | VA |