Wilson, Derron
Wilson, Derron is an individual health care provider with primary practice located at 13345 Illinois St , Carmel IN 46032-3318. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pain Medicine, which is considered as his primary health care specialty. Wilson, Derron can be contacted via phone (317) 396-1300.Contact Information
Primary practice address
13345 Illinois St
Carmel IN 46032-3318
Phone: (317) 396-1300
Fax: (317) 870-2728
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 01047150A | Indiana |
Profile Details
| NPI number | 1780669267 |
|---|---|
| LBN Legal business name | Wilson, Derron |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 7th, 2005 |
| Last updated | Feb 22nd, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780669267 | NPPES |
| Indiana | MEDICAID | 200313770B |
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