NPI 1720401789

Glenn Wilson, IDMT

Practitioner Independent Duty Medical Technicians Holloman Afb, NM

Practice location

Address: 280 David L Goldfein St Bldg 23, Holloman Afb, NM 88330-8273
Phone: (707) 424-5107
Mailing address: 228 Seabury St, Suisun City, CA 94585-4107

Registered specialties

Independent Duty Medical Technicians Primary

Other Service Providers Taxonomy 1710I1003X

Other Military Health Care Provider providers in New Mexico →

Registry record

NPI: 1720401789
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Jan 2014
Record last updated: 29 Mar 2024

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.