NPI 1104071224

John David Wilson, MD

Practitioner Family Medicine Physician Grants Pass, OR

Practice location

Address: 495 SW Ramsey Ave, Grants Pass, OR 97527-5681
Phone: (541) 476-6644

Registered specialties (2)

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X Licence 150495 (OR)

Other Family Medicine providers in Oregon →

Adult Medicine Physician

Allopathic & Osteopathic Physicians Taxonomy 207QA0505X Licence MD37095 (TN)

Registry record

NPI: 1104071224
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 Nov 2008
Record last updated: 6 Jul 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.