Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0004538 | FL |
NPI | 1851382410 |
---|---|
Provider Name | Dr. Steven A. Wilson |
First Address | Brandon, FL 33511-5342 |
Second Address | Brandon, FL 33511-5342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 18/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T91431 | (02) | FL |