Healthcare Provider Details

I. General information

NPI: 1992736367
Provider Name (Legal Business Name): BYRON ERIC WILSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20055 LAKE CHABOT RD #130
CASTRO VALLEY CA
94546
US

IV. Provider business mailing address

5725 W LAS POSITAS BLVD #100
PLEASANTON CA
94588-4054
US

V. Phone/Fax

Practice location:
  • Phone: 510-888-0657
  • Fax: 510-886-4532
Mailing address:
  • Phone: 925-734-8130
  • Fax: 925-225-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberG72444
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG72444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: