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General NPI Number Information
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NPI Number | 1407808421
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Entity Type | Organization
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Legal Business Name | PARKER OB/GYN
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 16830 NORTHGATE DR
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City | PARKER
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State | CO
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Zip | 80134-5776
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Country | US
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Telephone | 303-841-5353
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Fax | 303-758-0779
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Provider Business Mailing Address
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Address Line | 16830 NORTHGATE DR
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City | PARKER
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State | CO
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Zip | 80134-5776
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Country | US
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Telephone | 303-841-5353
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Fax | 303-758-0779
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN R. WILSON
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Credential | M.D.
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Telephone | 303-841-5353
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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 | 22603
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License Number State | CO
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