Provider Demographics
NPI:1518908045
Name:WILSON, JAMES HENRY III (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
Last Name:WILSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-868-7222
Mailing Address - Fax:
Practice Address - Street 1:220 N SYKES CREEK PKWY STE 301
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3490
Practice Address - Country:US
Practice Address - Phone:321-868-7222
Practice Address - Fax:321-361-5543
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2025-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME153805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLWE215OtherHFMG
NYG54077Medicare UPIN
NYCC4980Medicare ID - Type Unspecified