Healthcare Provider Details

I. General information

NPI: 1265566749
Provider Name (Legal Business Name): MAYSVILLE OBSTETRIC & GYNECOLOGIC ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 MEDICAL PARK DR SUITE 309
MAYSVILLE KY
41056-8764
US

IV. Provider business mailing address

991 MEDICAL PARK DR SUITE 309
MAYSVILLE KY
41056-8764
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-5331
  • Fax: 606-759-5363
Mailing address:
  • Phone: 606-759-5331
  • Fax: 606-759-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. DONALD R WILSON
Title or Position: PRESIDENT
Credential: M. D.
Phone: 606-759-5331