Provider Demographics
NPI:1821100033
Name:WILSON-KING, GENESTER SYLVANNA (MD FACOG)
Entity Type:Individual
Prefix:
First Name:GENESTER
Middle Name:SYLVANNA
Last Name:WILSON-KING
Suffix:
Gender:F
Credentials:MD FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 N DONNELLY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32752
Mailing Address - Country:US
Mailing Address - Phone:352-735-7778
Mailing Address - Fax:352-735-4043
Practice Address - Street 1:1502 N DONNELLY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MT DORA
Practice Address - State:FL
Practice Address - Zip Code:32752
Practice Address - Country:US
Practice Address - Phone:352-735-7778
Practice Address - Fax:352-735-4043
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL49660207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology