MEDICARE: DR. ELIZABETH A WILSON M.D.

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
1	207VG0400X	Gynecology Physician	108543	MO

General Provider Information

NPI Number	:	1750381141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH A WILSON M.D.

Provider Business Mailing Address
First Line	:	1601 E BROADWAY
Second Line	:	WOMEN'S HEALTH ASSOCIATES, INC.
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8020
Country	:	US
Telephone Number	:	573-443-8796
Fax Number	:	573-875-3949

Provider Business Practice Location Address
First Line	:	1601 E BROADWAY
Second Line	:	WOMEN'S HEALTH ASSOCIATES, INC.
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8020
Country	:	US
Telephone Number	:	573-443-8796
Fax Number	:	573-875-3943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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