Organization Name: | G SAM WILSON MD PC |
NPI Number: | 1962521120 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | G. SAM WILSON (PROVIDER) |
Mailing Address: | 440 Medical Dr Bountiful |
State: | UT US |
Postal Code: | 840104950 |
Phone Number: | 8012989100 |
Fax Number: | 8012982238 |
NPI Enumeration Date: | 03/28/2007 |
NPI Last Update Date: | 11/19/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 1754341205 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
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. |