Healthcare Provider Details

I. General information

NPI: 1851224653
Provider Name (Legal Business Name): SETH BIMSON WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-0704
  • Fax:
Mailing address:
  • Phone: 520-626-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberR82803
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: