JEROME LAURENCE WILSON

DYER, IN
NPI1588765010
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AS0400X Physician Assistant, Surgical
(Licence: IN  10002805A)
Additional Taxonomies363AS0400X Physician Assistant, Surgical
(Licence: IL  085001943)
Enumeration Date2006-09-26
Last Update Date2023-10-06
Business Address
JEROME LAURENCE WILSON PA-C
919 MAIN ST STE 101
DYER, IN 46311-3717
Phone number: 219-836-7531
Mailing Address
JEROME LAURENCE WILSON PA-C
PO BOX 781076
DETROIT, MI 48278-1076
Phone number: 317-528-4800