Provider Demographics
NPI:1003188517
Name:WILSON, WILLIAM CARREL (DVM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARREL
Last Name:WILSON
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 MAJOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501
Mailing Address - Country:US
Mailing Address - Phone:307-856-3298
Mailing Address - Fax:307-856-5014
Practice Address - Street 1:1599 MAJOR AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2326
Practice Address - Country:US
Practice Address - Phone:307-856-3298
Practice Address - Fax:307-856-5014
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY650174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian