Bruce Allen Wilson PA

NPI 1093767667 - Physician Assistant - 363AM0700X

NPI Details
NPI 1093767667
Gender Male
Enumeration Date 05/16/2006
Last Updated 04/09/2014
Entity Type Individual
Active Over 10 years ago
Practice Location
809 82ND PKWY
MYRTLE BEACH SC, 29572-4607, US
Phone (843) 497-5929
Fax (843) 839-4448
Business Location
4615 OLEANDER DR
SUITE 201A
MYRTLE BEACH SC, 29577-5741, US
Phone (843) 497-5929
Fax (843) 839-4448
Toxanomy
Taxonomy Code 363AM0700X
License State Michigan
License Number 5601003517
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According to our database, Bruce Allen Wilson PA NPI is 1093767667, taxonomy code is 363AM0700X and license number is 5601003517, license state is located at Michigan. Bruce Allen Wilson PA physically located at 809 82nd Pkwy, Myrtle Beach SC, 29572-4607. NPI Number Bruce Allen Wilson PA has the Individual type.

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1093767667 NPI number is provided on an as is basis without warranty of any kind. 1093767667 is maintained by the National Plan & Provider Enumeration System. The contents of Bruce Allen Wilson PA are for informational purposes only.