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General NPI Number Information
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NPI Number | 1891742094
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Entity Type | Individual
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Provider Name | DEBORAH DYNE WILSON PHYSICIAN
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Gender | Female
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 10250 N 92ND ST STE 102
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4517
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Country | US
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Telephone | 480-860-4791
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Fax | 480-860-6314
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Provider Business Mailing Address
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Address Line | 10250 N 92ND ST STE 102
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4517
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Country | US
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Telephone | 480-860-4791
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Fax | 480-860-6314
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD26168
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License Number State | AZ
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