Healthcare Provider Details

I. General information

NPI: 1376606533
Provider Name (Legal Business Name): JAMES R WILSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 LANDOVER BOULEVARD
SPRING HILL FL
34608-7260
US

IV. Provider business mailing address

3017 LANDOVER BOULEVARD
SPRING HILL FL
34608
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-8120
  • Fax: 352-683-4588
Mailing address:
  • Phone: 352-683-8120
  • Fax: 352-683-4588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME0014846
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES ROBERT WILSON
Title or Position: OWNER
Credential: MD
Phone: 352-683-8120