Provider Demographics
NPI:1265758353
Name:WILSON, REBEKAH L (MD)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8075 GATE PKWY W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3684
Mailing Address - Country:US
Mailing Address - Phone:904-279-8202
Mailing Address - Fax:904-279-8248
Practice Address - Street 1:8075 GATE PKWY W
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3684
Practice Address - Country:US
Practice Address - Phone:904-279-8202
Practice Address - Fax:904-279-8248
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME120623207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology