Provider Demographics
NPI:1194706754
Name:ASFORA MD FRCSC PC, WILSON T (MD)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:T
Last Name:ASFORA MD FRCSC PC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:900 BISCAYNE BLVD APT 5501
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1576
Mailing Address - Country:US
Mailing Address - Phone:305-646-9797
Mailing Address - Fax:305-921-9682
Practice Address - Street 1:900 BISCAYNE BLVD APT 5501
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1576
Practice Address - Country:US
Practice Address - Phone:305-464-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD340207T00000X
SD3404207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDE75059Medicare UPIN
SDP00419560Medicare PIN
SDS5279Medicare PIN