Healthcare Provider Details

I. General information

NPI: 1902499544
Provider Name (Legal Business Name): ALLISON WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST FL 5
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

9040 JACKSON AVE
TACOMA WA
98431-3158
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7528
  • Fax:
Mailing address:
  • Phone: 253-968-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA209327
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35272
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: