Provider Demographics
NPI:1477541563
Name:WILSON, ALAN KIRK (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KIRK
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 UNITY RD
Mailing Address - Street 2:B505
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-9443
Mailing Address - Country:US
Mailing Address - Phone:870-364-4013
Mailing Address - Fax:870-364-4184
Practice Address - Street 1:1015 UNITY RD
Practice Address - Street 2:B505
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-4013
Practice Address - Fax:870-364-4184
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1594208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K637OtherBCBS
AR180320000OtherQUALCHOICE
AR020036876OtherMEDICARE RAILROAD
AR132894001Medicaid
AR020036876OtherMEDICARE RAILROAD