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General NPI Number Information
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NPI Number | 1083077507
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Entity Type | Individual
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Provider Name | ELIZABETH WILSON D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 1725 N MCKENZIE ST
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City | FOLEY
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State | AL
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Zip | 36535-2249
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Country | US
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Telephone | 251-943-2141
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Fax | 251-943-2846
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Provider Business Mailing Address
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Address Line | 2546 SW 74TH TER
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City | DAVIE
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State | FL
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Zip | 33317-7028
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Country | US
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Telephone | 954-475-5758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | DO.1832
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | OS21802
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License Number State | FL
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