=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104812882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DELANO DONALD WILSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2005
-----------------------------------------------------
Last Update Date | 12/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10TH MDG 4102 PINION DR.
-----------------------------------------------------
City | UAAF ACADEMY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80840-8084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-333-5439
-----------------------------------------------------
Fax | 719-333-0507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17405 POND VIEW PL
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80908-5303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-416-9120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | DR.0043346
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 35056348
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------