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General NPI Number Information
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NPI Number | 1477633121
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Entity Type | Organization
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Legal Business Name | VICTOR T. WILSON MD PC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 700 WALL ST
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City | NORMAN
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State | OK
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Zip | 73069-6360
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Country | US
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Telephone | 405-360-7337
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Fax | 866-259-0044
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Provider Business Mailing Address
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Address Line | PO BOX 721678
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City | NORMAN
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State | OK
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Zip | 73070-8284
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Country | US
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Telephone | 405-360-7337
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Fax | 866-259-0044
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR T. WILSON
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Credential | M.D.
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Telephone | 405-360-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 17516
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License Number State | OK
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