Healthcare Provider Details

I. General information

NPI: 1386272854
Provider Name (Legal Business Name): JOHN THOMAS WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 N 9TH AVE
PENSACOLA FL
32503-2824
US

IV. Provider business mailing address

1040 GULF BREEZE PKWY STE 100
GULF BREEZE FL
32561-7808
US

V. Phone/Fax

Practice location:
  • Phone: 850-807-4200
  • Fax: 850-916-8499
Mailing address:
  • Phone: 448-227-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number73192
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME180914
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME180914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: