Healthcare Provider Details

I. General information

NPI: 1477633121
Provider Name (Legal Business Name): VICTOR T. WILSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WALL ST
NORMAN OK
73069-6360
US

IV. Provider business mailing address

PO BOX 721678
NORMAN OK
73070-8284
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-7337
  • Fax: 866-259-0044
Mailing address:
  • Phone: 405-360-7337
  • Fax: 866-259-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17516
License Number StateOK

VIII. Authorized Official

Name: DR. VICTOR T. WILSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-360-7337