Individual
DR. THOMAS A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1010 MURRAY AVE, SAN LUIS OBISPO, CA 93405-1806
(805) 546-7692
(805) 546-7932
Mailing address
PO BOX 16012, SAN LUIS OBISPO, CA 93406-6012
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
151531
NY
2080P0205X
Pediatric Endocrinology Physician
Primary
G30444
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00725544
—
NY
01
—
4249553
AETNA
NY
01
—
79A002
EMPIRE BC.BS
NY
Enumeration date
06/12/2006
Last updated
05/19/2020
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