Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
SHANE CHARLES WILSON, DO
Active Sole ProprietorSHANE CHARLES WILSON, DO is a Internal Medicine healthcare provider located in MEMPHIS, Missouri. NPI 1477808467 is currently active in the NPPES registry. Verify at CMS.
Internal Medicine · MEMPHIS, MO
Registration Details
- NPI Number
- 1477808467
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 17, 2012 (14.094404604014 yrs)
- Last Updated
- Oct 8, 2015
- License
-
2014026613 (MO)
- Sole Proprietor
- Yes
Practice Information
- Address
-
450 E SIGLER AVESTE AMEMPHIS, MO, 635551726Browse MO providers · Browse ZIP 63555
- Phone
- 6604652828
- Fax
- 6604652956
- Primary Specialty
-
Internal Medicine
207R00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.