Most Relevant Information
Provider Data
| NPI Number: | 1003298571 |
| Provider Name: | EVAN JONATHAN WILSON IDC |
| Entity Type: | Individual |
| Taxonomy Code: | 1710I1002X |
| Specialty: | Military Health Care Provider |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/22/2015 |
| Last Updated: | 09/16/2015 |
Provider Practice Location
2989 EAST AROW ST
YUMA
AZ
85365
Practice Location Phone/Fax
| Phone: | 3104087127 |
| Fax: |
Provider Mailing Location
1617 E REILLY ST
APT C
YUMA
AZ
853655659
Provider Mailing Phone/Fax
| Phone: | 3104087127 |
| Fax: |