MEDICARE: DAVID SCOTT WILSON

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	390200000X	Student in an Organized Health Care Education/Training Program	PHA-PIN-LIC-88925	MT

General Provider Information

NPI Number	:	1346137668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SCOTT WILSON

Provider Business Mailing Address
First Line	:	724 STODDARD ST APT 1
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-2555
Country	:	US
Telephone Number	:	406-529-9727
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 STEVENSVILLE CUTOFF RD
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-6496
Country	:	US
Telephone Number	:	406-444-7710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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Directions to “ DAVID SCOTT WILSON ” Practice Location

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