Provider Demographics
NPI:1922366020
Name:WILSON, STEPHEN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
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 1:1738 CITRON ST
Mailing Address - Street 2:#ER
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2571
Mailing Address - Country:US
Mailing Address - Phone:808-398-3761
Mailing Address - Fax:
Practice Address - Street 1:1738 CITRON ST
Practice Address - Street 2:#ER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2571
Practice Address - Country:US
Practice Address - Phone:808-398-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4668207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology