MEDICARE: DR. DONALD WENDELL WILSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	007242	ME

General Provider Information

NPI Number	:	1356670137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD WENDELL WILSON M.D.

Provider Business Mailing Address
First Line	:	1599 NW SWEETBAY CIRCLE
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-8014
Country	:	US
Telephone Number	:	772-336-8841
Fax Number	:	772-336-8841

Provider Business Practice Location Address
First Line	:	1599 NW SWEETBAY CIRCLE
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-8014
Country	:	US
Telephone Number	:	772-336-8841
Fax Number	:	772-336-8841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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