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MR. FRED EUGENE WILSON MD
Rural Health >> Clinic/Center >> Ambulatory Health Care FacilitiesRegistrant NPI Number: 1265530984
Individual Registrant:MR. FRED EUGENE WILSON MD
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
908 NORTH EDMONDS MC CRORY, AR 72101-0780 US
Tel: 870-731-1100 Fax: 870-731-1019
Tel: 870-731-1100 Fax: 870-731-1019
Contact information for business:
PO BOX 780 908 NORTH EDMONDS MC CRORY, AR 72101-0780 US
Tel: 870-731-1100 Fax: 870-731-1019
Tel: 870-731-1100 Fax: 870-731-1019
Registration Information:
NPI: 1265530984
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 261QR1300X | Ambulatory Health Care Facilities Clinic/Center Rural Health |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 134474729 | AR | 05 | |
| 134056002 | AR | 05 |
