Provider Demographics
NPI:1821488727
Name:BRUCE WILSON MD PC
Entity Type:Organization
Organization Name:BRUCE WILSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-316-1555
Mailing Address - Street 1:5885 AIRLINE RD
Mailing Address - Street 2:# 985
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5127
Mailing Address - Country:US
Mailing Address - Phone:901-317-7360
Mailing Address - Fax:901-317-7585
Practice Address - Street 1:5885 AIRLINE RD
Practice Address - Street 2:# 985
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-5127
Practice Address - Country:US
Practice Address - Phone:901-317-7360
Practice Address - Fax:901-317-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGOtherMEDICARE
TNPENDINGMedicaid