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General NPI Number Information
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NPI Number | 1184954851
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Entity Type | Individual
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Provider Name | TERENCE BENJAMIN WILSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2010
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Last Update Date | 01/02/2010
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Provider Practice Location Address
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Address Line | 7 NORFORK CV
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City | MAUMELLE
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State | AR
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Zip | 72113-6538
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Country | US
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Telephone | 501-803-0361
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Fax |
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Provider Business Mailing Address
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Address Line | 7 NORFORK CV
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City | MAUMELLE
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State | AR
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Zip | 72113-6538
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Country | US
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Telephone | 501-803-0361
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C-4907
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License Number State | AR
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