Individual
JEROMY GLENN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
3520 W 92ND AVE, WESTMINSTER, CO 80031-3303
(303) 429-6600
(303) 429-6601
Mailing address
6080 W 92ND AVE, SUITE 1000, WESTMINSTER, CO 80031-2928
(303) 427-0796
(303) 429-9399
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2560
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1080625
NCCPA
—
Enumeration date
01/08/2008
Last updated
11/16/2023
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