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NPI Code Detail

MEDICARE: CHARLES V. WILSON JR. MD

MEDICARE: CHARLES V. WILSON JR. MD
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
1174400000XSpecialistAW 1670757FL

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 : 1699702910
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES V. WILSON JR. MD
Provider Business Mailing Address
First Line : 3525A US HIGHWAY 17
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-7122
Country : US
Telephone Number : 904-215-3880
Fax Number : 904-215-3883
Provider Business Practice Location Address
First Line : 3525A US HIGHWAY 17
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-7122
Country : US
Telephone Number : 904-215-3880
Fax Number : 904-215-3883
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 11/09/2009

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