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NPI Code Detail

MEDICARE: DR. DAVID S WILSON MD

MEDICARE:  DR. DAVID S WILSON  MD
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
1207R00000XInternal Medicine Physician22903OK

General Provider Information

NPI Number : 1740377027
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID S WILSON MD
Provider Business Mailing Address
First Line : 13313 N MERIDIAN AVE STE C
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-8316
Country : US
Telephone Number : 405-254-9690
Fax Number : 405-254-9691
Provider Business Practice Location Address
First Line : 13313 N MERIDIAN AVE STE C
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-8316
Country : US
Telephone Number : 405-254-9690
Fax Number : 405-254-9691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 11/28/2012

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Directions to “ DR. DAVID S WILSON MD” Practice Location

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