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General NPI Number Information
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NPI Number | 1295781359
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Entity Type | Individual
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Provider Name | CHARLES A WILSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 6360 BOULDER HWY
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City | LAS VEGAS
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State | NV
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Zip | 89122-7301
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Country | US
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Telephone | 725-228-4520
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Fax | 877-889-5390
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Provider Business Mailing Address
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Address Line | PO BOX 616788
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City | ORLANDO
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State | FL
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Zip | 32861-6788
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Country | US
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Telephone | 407-533-6836
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Fax | 407-232-9316
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1782
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License Number State | NV
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