Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD031223 | TN |
NPI | 1063429124 |
---|---|
Provider Name | Dr. Timothy Scott Wilson |
First Address | Knoxville, TN 37923 |
Second Address | Knoxville, TN 37923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3113404 | BCBS OF TN (01) | TN |
3718742 | (05) | TN |
G52968 | (02) |