Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 17658 | NE |
N | 2080P0214X | Pediatric Pulmonologist | 17658 | NE |
NPI | 1407808793 |
---|---|
Provider Name | Dr. Mark C Wilson |
First Address | Omaha, NE 68114-4113 |
Second Address | Omaha, NE 68114-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1926246 | (05) | IA |
31219 | BCBS (01) | NE |
662 | MIDLANDS CHOICE (01) | |
7781510 | (05) | SD |
94533 | BCBS (01) | IA |
D44650 | (02) | NE |