Bryant Thomas Wilson PA-C

NPI 1013103001 - Physician Assistant - 363A00000X

NPI Details
NPI 1013103001
Gender Male
Enumeration Date 09/24/2007
Last Updated 04/18/2013
Entity Type Individual
Active Over 9 years ago
Practice Location
3264 N EVERGREEN DR NE
GRAND RAPIDS MI, 49525-9746, US
Phone (616) 363-7339
Fax (616) 361-5828
Business Location
3264 N EVERGREEN DR NE
GRAND RAPIDS MI, 49525-9746, US
Phone (616) 363-7339
Fax (616) 361-5828
Toxanomy
Taxonomy Code 363A00000X
License State Michigan
License Number 5601004603
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According to our database, Bryant Thomas Wilson PA-C NPI is 1013103001, taxonomy code is 363A00000X and license number is 5601004603, license state is located at Michigan. Bryant Thomas Wilson PA-C physically located at 3264 N Evergreen Dr Ne, Grand Rapids MI, 49525-9746. NPI Number Bryant Thomas Wilson PA-C has the Individual type.

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1013103001 NPI number is provided on an as is basis without warranty of any kind. 1013103001 is maintained by the National Plan & Provider Enumeration System. The contents of Bryant Thomas Wilson PA-C are for informational purposes only.