Basic Information
| Provider Information | |||||||||
| NPI: | 1093715179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | ROCKEY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 716 | ||||||||
| Address2: | |||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161460716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247048886 | ||||||||
| FaxNumber: | 7243421942 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 GREEN ST BLDG B | ||||||||
| Address2: | |||||||||
| City: | FARRELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161211399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243426900 | ||||||||
| FaxNumber: | 7243426905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS004015L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.