Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 10332056-1205 | UT |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME137286 | FL |
NPI | 1659647550 |
---|---|
Provider Name | Thomas Cooper Wilson |
First Address | St Petersburg, FL 33701-4629 |
Second Address | St Petersburg, FL 33701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 19/07/2018 |