Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | C51286 | CA |
NPI | 1043211675 |
---|---|
Provider Name | Steven Karl Wilson |
First Address | Deerfield Beach, FL 33441-5197 |
Second Address | Indio, CA 92201-5518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C512861 | PPIN (01) | CA |
B02897 | (02) |