Provider Demographics
NPI:1144226705
Name:WILSON, EDWARD R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:924 MONTCLAIR RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1200
Mailing Address - Country:US
Mailing Address - Phone:205-591-7999
Mailing Address - Fax:205-591-5051
Practice Address - Street 1:924 MONTCLAIR RD
Practice Address - Street 2:STE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1200
Practice Address - Country:US
Practice Address - Phone:205-591-7999
Practice Address - Fax:205-591-5051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8926207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKC75656Medicare UPIN
AL7476Medicare ID - Type UnspecifiedMEDICARE