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General NPI Number Information
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NPI Number | 1275777351
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Entity Type | Organization
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Legal Business Name | W. BRUCE WILSON, MD PC
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 850 E. HARVARD AVE. SUITE 355
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City | DENVER
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State | CO
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Zip | 80210-5033
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Country | US
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Telephone | 303-733-5333
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Fax | 303-733-5386
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Provider Business Mailing Address
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Address Line | 850 E. HARVARD AVE. SUITE 355
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City | DENVER
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State | CO
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Zip | 80210-5033
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Country | US
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Telephone | 303-733-5333
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Fax | 303-733-5386
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. W. BRUCE WILSON
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Credential | M.D. P.C.
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Telephone | 303-733-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16962
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License Number State | CO
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