Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 30774 | AL |
NPI | 1316100670 |
---|---|
Provider Name | Dr. Patrick C Wilson |
First Address | Huntsville, AL 35801 |
Second Address | Huntsville, AL 35801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 02/06/2015 |