Healthcare Provider Details

I. General information

NPI: 1457333247
Provider Name (Legal Business Name): CLAIRE MARIE WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 PROVIDENCE DR TOWER A, SUITE 567
ANCHORAGE AK
99508-4691
US

IV. Provider business mailing address

PO BOX 4105
PORTLAND OR
97208-4105
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-2240
  • Fax: 907-212-2872
Mailing address:
  • Phone: 866-907-1067
  • Fax: 425-917-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberG45530
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number7027
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: