Provider Demographics
NPI:1518049873
Name:WILSON, NEVIN W (MD)
Entity Type:Individual
Prefix:DR
First Name:NEVIN
Middle Name:W
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-671-2355
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:3006 S MARYLAND PKWY
Practice Address - Street 2:SUITE 315
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2218
Practice Address - Country:US
Practice Address - Phone:702-992-6868
Practice Address - Fax:702-992-6860
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV12229207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0107913000Medicaid
WV0107913000Medicaid
WVWI6024051Medicare ID - Type Unspecified