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General NPI Number Information
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NPI Number | 1265787303
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Entity Type | Organization
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Legal Business Name | GREGORY B. WILSON, M.D., INC.
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 1329 LUSITANA ST SUITE 604
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City | HONOLULU
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State | HI
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Zip | 96813-2429
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Country | US
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Telephone | 808-531-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 1329 LUSITANA ST SUITE 604
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City | HONOLULU
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State | HI
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Zip | 96813-2429
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Country | US
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Telephone | 808-531-1116
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GREGORY B WILSON
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Credential | M.D.
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Telephone | 808-735-9093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD-03515
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License Number State | HI
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