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NPI Code Detail

MEDICARE: BRADLEY C WILSON DO

MEDICARE:   BRADLEY C WILSON  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician34004144OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225020878
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY C WILSON DO
Provider Business Mailing Address
First Line : PO BOX 1821
Second Line :
City : ZANESVILLE
State : OH
Zip : 43702-1821
Country : US
Telephone Number : 740-455-3304
Fax Number : 740-455-3686
Provider Business Practice Location Address
First Line : 7756 STATE ROUTE 37 E
Second Line :
City : NEW LEXINGTON
State : OH
Zip : 43764-9512
Country : US
Telephone Number : 740-342-3540
Fax Number : 740-342-3879
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 10/14/2010

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Directions to “ BRADLEY C WILSON DO” Practice Location

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