Provider Demographics
NPI:1952377129
Name:WILSON, JAMES P (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:1700 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3190
Practice Address - Country:US
Practice Address - Phone:877-748-1114
Practice Address - Fax:941-499-5409
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2024-08-19
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Provider Licenses
StateLicense IDTaxonomies
FLME0039417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD32866Medicare UPIN