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General NPI Number Information
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NPI Number | 1710470703
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Entity Type | Organization
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Legal Business Name | MARK D WILSON, MD INC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 400 W PUEBLO ST
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City | SANTA BARBARA
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State | CA
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Zip | 93105-4353
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Country | US
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Telephone | 805-682-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 780 LA BUENA TIERRA
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City | SANTA BARBARA
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State | CA
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Zip | 93111-1705
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Country | US
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Telephone | 805-637-1120
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DANIEL WILSON
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Credential | MD
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Telephone | 805-637-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A76869
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License Number State | CA
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