MEDICARE: W. BRUCE WILSON, MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	16962	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275777351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W. BRUCE WILSON, MD PC

Provider Business Mailing Address
First Line	:	850 E. HARVARD AVE.
Second Line	:	SUITE 355
City	:	DENVER
State	:	CO
Zip	:	80210-5033
Country	:	US
Telephone Number	:	303-733-5333
Fax Number	:	303-733-5386

Provider Business Practice Location Address
First Line	:	850 E. HARVARD AVE.
Second Line	:	SUITE 355
City	:	DENVER
State	:	CO
Zip	:	80210-5033
Country	:	US
Telephone Number	:	303-733-5333
Fax Number	:	303-733-5386

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. W. BRUCE WILSON
Credential	:	M.D. P.C.
Telephone Number	:	303-733-5333

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	12/11/2009

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