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General NPI Number Information
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NPI Number | 1366861841
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Entity Type | Individual
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Provider Name | WILLIAM CASSIDY WILSON IV MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 2200 E PARRISH AVE BLDG D
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City | OWENSBORO
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State | KY
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Zip | 42303-1458
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Country | US
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Telephone | 270-926-8171
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Fax |
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE CB 8131
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone | 314-362-7200
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Fax | 314-747-4189
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 2019009534
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2019009534
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 53142
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License Number State | KY
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