| Doctor Name: | DR. STEPHEN M WILSON |
| NPI Number: | 1245301084 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | G23030 |
| Business Practice Address: | 1950 Sunnycrest Dr Suite 2600 Fullerton, CA - 928353638 |
| Business Phone Number: | 7144465260 |
| Business Fax Number: | 7144465265 |
| Mailing Address: | 279 Imperial Hwy, Suite 730 FULLERTON |
| State: | CA |
| Postal Code: | 928351041 |
| Phone Number: | 7144494841 |
| Fax Number: | 7144494956 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 04/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | G23030 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |