Physician Compare National (NPI:1922366020)

HEALTHCARE PROVIDER: STEPHEN JAMES WILSON M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1922366020
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7113293911
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171023002486
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILSON
	Individual professional last name
Provider First Name	STEPHEN
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	YALE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1314 S KINGS ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 653
	Group Practice or individual's line 2 address
City	HONOLULU
	Group Practice or individual's city
State	HI
	Group Practice or individual's state
Zip Code	968141979
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8085919208
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y